Early COVID-19 outbreak

This outdated article from April 2020 is being kept for its historical perspective. The current article can be found at Recent COVID-19 outbreak.

Map of outbreak
U.S. Health Weather Map
EPA approved cleaning products here
Recommended: N95 respirator (The coronavirus measures 0.12 microns in diameter)
Any particles that are smaller than 5 microns can enter the alveoli of the lungs
See also: N95 masks can be effectively sterilized and reused
California COVID-19 risk screening and testing

See also: Wikipedia:Category:2019–20 coronavirus pandemic by country

The **2019-20 coronavirus outbreak** is an ongoing epidemic of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2, which started in December 2019. It was first identified in Wuhan, capital of Hubei province China, after 41 people presented with pneumonia of no clear cause.

The virus primarily spreads between people in a similar way to influenza, via respiratory droplets produced during coughing or sneezing. The time between exposure and symptom onset is typically five days, but may range from two to fourteen days. Symptoms may include fever, cough, and shortness of breath. Complications may include pneumonia and acute respiratory distress syndrome. There is no vaccine or specific antiviral treatment, with efforts typically to management symptoms and support functioning. Hand washing is recommended to prevent spread of the disease. Anyone who is suspects of carrying the virus is advised to monitor their health for two weeks, wear a mask, and seek medical advice by calling a doctor rather than directly visiting a clinic.

As of 4 March 2020, more than 94,000 cases have been confirmed, of which 7,100 were classified as serious. 82 countries and territories have been affected, with major outbreaks in Central China, South Korea, Italy, and Iran. More than 3,200 people have died: almost 3,000 in mainland China and about 240 in other countries. This surpasses the deaths from the 2003 SARS outbreak. More than 51,000 people have recovered

Various experts have speculated on the possible number of persons that may be infected, which they believe might be larger than the number of confirmed cases.

The outbreak has been declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO). Health authorities have been working to contain the spread of the disease since its discovery. China has introduced travel restrictions, quarantines, and outdoor restrictions—requiring families to stay at home—affecting over 170 million people. Several countries have issued advisories warning against travel to regions with ongoing community transmission, such as Central China, Italy and Iran. Airports and train stations have implemented body temperature checks, health declarations, and information signage in an attempt to identify carriers of the virus.

Misinformation has spread about the coronavirus, primarily online, which the WHO described as an "infodemic" on 2 February 2020. The epidemic has led to further consequences beyond quarantine measures and its impact on health, including concerns over potential economic instability and cancellation of several events expected to be attended by people travelling from areas with high risk of contagion. Political consequences have included a number of local leaders of the Chinese Communist Party being fired due to their response to the outbreak and increased protest activity in Hong Kong. Reports of xenophobia and racism against people of Chinese and East Asian descent have arisen as a result of the outbreak, with fear and hostility occurring in several countries.

## Overview

Wuhan is the capital of Hubei and is the seventh-largest city in China, with a population of more than 11 million people. It has been a major transport hub of the country for centuries and known as "Nine Provinces' Thoroughfare" (Chinese: 九省通衢) since at least the 17th century, and the Wuhan Railway Hub is one of the four most important railway hubs in China. It is approximately 1,050 km (650 mi) south of Beijing, 700 km (430 mi) west of Shanghai, and 900 km (560 mi) north of Hong Kong. Direct international flights from Wuhan connect it to major cities in Europe and North America.

Coronaviruses mainly circulate among other animals but have been known to evolve and cause coronavirus outbreaks in humans as in the cases of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) together with four further coronaviruses that cause mild respiratory symptoms similar to the common cold. SARS-CoV-2's nucleic acid sequence is 75 to 80 percent identical to severe acute respiratory syndrome coronavirus (SARS-CoV), and more than 85-percent similar to several bat coronaviruses. All coronaviruses known to infect humans have been shown to spread between people. Transmission of coronaviruses is primarily thought to occur among close contacts via respiratory droplets generated by sneezing and coughing.

In Wuhan, during December 2019, a cluster of cases displaying the symptoms of a "pneumonia of unknown cause" was linked to Huanan Seafood Wholesale Market, which had a thousand stalls selling fish, chickens, pheasants, bats, marmots, venomous snakes, spotted deer, and other wild animals (*ye wei*, bushmeat). In January 2020, the hypothesis was that this was a novel coronavirus from an animal source (a zoonosis).

## Epidemiology

Main articles: Timeline of the 2019–20 coronavirus outbreak in December 2019 – January 2020, ... February 2020|Timeline of the 2019–20 coronavirus outbreak in February 2020|... February 2020, 2019–20 coronavirus outbreak by country and territory

The earliest reported symptoms occurred on 1 December 2019 in a person who had not had any exposure to the Huanan Seafood Wholesale Market or to the remaining 40 of the first cluster detected with the new virus. Of this first cluster, two-thirds were found to have a link with the market, which also sold live animals. Of cases that began before 1 January 2020, 55% were linked to the market. By 22 January this figure was reported to have dropped to 8.6%. Hence, as the number of cases has increased, the significance of the market has lessened.

During the early stages, the number of cases doubled approximately every seven and a half days. In early and mid-January 2020, the virus spread to other Chinese provinces, helped by the Chinese new year migration. On 20 January, China reported nearly 140 new patients, including two people in Beijing and one in Shenzhen.

The virus was soon carried to other countries by international travellers: Thailand (13 January); Japan (15 January); Macau (19 January); South Korea (20 January); Taiwan and the United States (21 January); Hong Kong (22 January); Singapore (23 January); France, Nepal, and Vietnam (24 January); Australia and Malaysia (25 January); Canada (26 January); Cambodia (27 January); Germany (28 January); Finland, Sri Lanka, and the United Arab Emirates (29 January); India, Italy, and the Philippines (30 January); the United Kingdom, Russia, Sweden, and Spain (31 January); Belgium (4 February); Egypt (14 February).

By 25 January the number of laboratory-confirmed cases stood at 2,062, including 2,016 in Mainland China, 7 in Thailand, 6 in Hong Kong, 5 in Macau, 5 in Australia, 4 in Malaysia, 4 in Singapore, 3 in France, 3 in Japan, 3 in South Korea, 3 in Taiwan, 3 in the United States, 2 in Vietnam, 1 in Nepal, and 1 in Sweden.

Citing 7,711 cases essentially in China and 83 cases abroad across 18 countries as of 29 January, WHO declared the outbreak to be a Public Health Emergency of International Concern on 30 January. As of 18 February, 73,437 cases have been confirmed worldwide, over 98% in mainland China.

On 6 February, the Chinese National Health Commission (NHC) started to change how cases were reported – asymptomatic carriers, who tested positive for the virus but did not show clinical symptoms, would no longer be included in the number of confirmed cases. This had the effect of reducing the total number of cases reported, but also meant that potentially contagious individuals were ignored in reports.

On 12 February, the Hubei government adopted a broader definition of confirmed cases, which now includes clinically diagnosed patients diagnosed by their symptoms and CT scans but without nucleic acid test, which can take days to process and delay treatment. "Using CT scans that reveal lung infection would help patients receive treatment as soon as possible and improve their chances of recovery," the provincial health commission said. This new methodology accounts for the sharp increase in Hubei's daily confirmed cases: 13,332 of the 14,840 newly confirmed cases in the province on 12 February were diagnosed clinically under the new definition.

Map of COVID-19 cases in mainland ChinaMap of the 2019–20 COVID-19 outbreak as of 16 January 2024
  Region of origin (mainland China)
  Confirmed cases reported

  Suspected cases reported

### Deaths

The time from development of symptoms of COVID-19 and death has been shown to range between 6 and 41 days, with a median of 14 days.

As of 4 March 2020[update], more than 3,200 deaths have been attributed to COVID-19. According to China's NHC, most of those who died were older patients – about 80% of deaths recorded were from those over the age of 60, and 75% had pre-existing health conditions including cardiovascular diseases and diabetes.

The first confirmed death was 9 January 2020 in Wuhan. The first death outside China occurred in the Philippines, and the first death outside Asia was in Paris. As of 28 February 2020[update], outside of mainland China, more than a dozen deaths have been recorded in each of Iran, South Korea, and Italy. Deaths have also been reported in North America, Australia, San Marino, Spain and Iraq.

As of 3 March 2020, WHO data shows the percentage of patients who have died from COVID-19 is 3.4% globally (1.6% outside of China).

Cases in ChinaCases outside ChinaSemi-log plot of cumulative incidence of confirmed cases and deaths in China and the rest of the world (ROW)Case Fatality Rates by age group from SARS-COV-2 in China.Semi-log plot of daily new confirmed cases by region: Hubei Province, mainland China excluding Hubei, the rest of the world (ROW), and the world totalSemi-log plot of coronavirus daily deaths by region: Hubei Province, mainland China excluding Hubei, the rest of the world (ROW), and the world total

### Estimates

On 17 January, a research group from the Imperial College London in the United Kingdom published a report that there had been 1,723 cases (95% confidence interval, 427–4,471) with onset of symptoms by 12 January. This was based on the pattern of the initial spread to Thailand and Japan. They also concluded that "self-sustaining human-to-human transmission should not be ruled out", which has since been confirmed. As further cases came to light, they later recalculated that there may be 4,000 symptomatic cases in Wuhan City by 18 January (uncertainty range of 1,000 to 9,700). A Hong Kong University group has reached a similar conclusion as the earlier study, with additional detail on transport within China.

Based on cases reported and assuming a 10-day delay between infection and detection, researchers at Northeastern University estimated that the number of actual infections may be much higher than those confirmed at the time of reporting. Northeastern University estimated 21,300 infections by 26 January, increasing to 31,200 infections by 29 January (95% confidence interval 23,400–40,400). On 31 January 2020, an article in *The Lancet* estimated that 75,815 individuals (95% confidence interval 37,304–130,330) had been infected in Wuhan as of 25 January, with an estimated doubling time of 6.4 days in the period of study.

There are concerns about whether adequate medical personnel and equipment are available in regions affected by the outbreak for hospitals to correctly identify coronavirus cases instead of misdiagnosing suspected cases as "severe pneumonia". Many of those experiencing symptoms were told to self-quarantine at home instead of going to a hospital to avoid close contact with other patients with different levels of symptoms. After two repatriation flights were conducted from Wuhan to Japan in late January, 5 out of approximately 400 persons repatriated were diagnosed with the virus, of whom 1 was symptomatic, and 4 were not.

## Signs and symptoms

Main articles: Coronavirus disease 2019

Those infected may either be asymptomatic or develop symptoms such as fever, cough, fatigue, shortness of breath, or muscle pain. Upper respiratory symptoms, such as sneezing, a runny nose, and sore throat, are less frequent. A WHO review of 55,924 laboratory-confirmed cases in China indicated the following typical signs and symptoms:

Further development can lead to severe pneumonia, acute respiratory distress syndrome, kidney failure, sepsis, septic shock, and death.

Among 137 early cases that were admitted to hospitals in Hubei province, 16 (12%) individuals died. Many of those who died had other conditions such as hypertension, diabetes, or cardiovascular disease that impaired their immune systems. As of 18 February 2020, the number of severe cases is 11,795 (16%) out of 73,437 with 12,712 having recovered.

Some of those infected may be asymptomatic, returning test results that confirm infection but show no clinical symptoms, so researchers have issued advice that individuals with close contact to confirmed infected patients should be closely monitored and examined to rule out infection.

The incubation period (the time between infection and symptom onset) ranges from one to 14 days, though is most commonly five days. However, one case is reported as having an incubation period of 27 days.

## Cause

### Transmission

The primary mode of transmission is through human-to-human transmission via respiratory droplets that people exhale (such as coughing or sneezing). Furthermore, these droplets can fall on surfaces (including tables, telephones and desks), so people are able to catch the COVID-19 virus if they touch a surface that has been contaminated by the virus, and then touch their eyes, nose or mouth.

The WHO is assessing whether asymptomatic transmission and fecal transmission are important transmission modes.

Droplets transmitting coronaviruses only stay suspended in the air for a short time. Details for the COVID-19 virus are not available as of 26 February 2020[update], and it is assumed that they are similar to other coronaviruses, which may stay viable and contagious on a metal, glass or plastic surface for up to nine days at room temperature. Disinfection of surfaces is possible with substances such as 62–71% ethanol applied for one minute.

There have been estimates for the basic reproduction number (the average number of people an infected person is likely to infect), ranging from 2.13 to 4.82. As of 24 January 2020[update] the virus was reported to have been able to transmit down a chain of up to four people. This is similar to severe acute respiratory syndrome-related coronavirus (SARS-CoV).

The WHO furthermore writes that though history with SARS and MERS show that transmission through food does not happen, the possibility remains open and that meat and animal products should be cooked thoroughly as a rule of thumb (note that milk in developed countries is usually pasteurized).

The virus is widely thought to have a zoonotic origin and hence most likely transmitted from animal to human, though the animal involved and the mode of transmission have not yet been identified.

### Virology

Main articles: Severe acute respiratory syndrome coronavirus 2
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus, first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases reported in Wuhan. It is the cause of coronavirus disease 2019 (COVID-19).

SARS-CoV-2 is closely related to the original SARS-CoV. It is thought to have a zoonotic origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in lineage B of the subgenus Sarbecovirus together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13). In February 2020, Chinese researchers found that there is only one amino acid difference in certain genome sequences between the viruses found in pangolins and those from human patients, implying that pangolins may have been an intermediate host.

## Diagnosis

The WHO (World Health Organization) has published several testing protocols for SARS-CoV-2 (also known as 2019-nCoV). Testing uses real time reverse transcription polymerase chain reaction (rRT-PCR). The test can be done on respiratory or blood samples. Results are generally available within a few hours to days.

Chinese scientists were able to isolate a strain of the coronavirus and publish the genetic sequence so that laboratories across the world could independently develop PCR tests to detect infection by the virus.

## Prevention

Recommended measures to prevent infection depend on the likelihood of a person coming into contact with the disease. The US CDC recommends avoiding exposure. A number of countries have advised against travel to either Mainland China, the province of Hubei, or just Wuhan. Other recommendations include frequent washing of hands with soap and water, not touching one's eyes, nose or mouth unless the hands are clean, and covering the mouth when one coughs. People in high risk areas should take additional precautions even around people that are not displaying symptoms.

Coronaviruses can survive for a few hours on surfaces. Methods to remove the virus from surfaces include chlorine-based disinfectants, 75% ethanol, peracetic acid, and chloroform.

There is no evidence that pets such as dogs and cats can be infected. The Government of Hong Kong warned anyone travelling outside the city to not touch animals; to not eat game meat; and to avoid visiting wet markets, live poultry markets, and farms.

### Hand washing

Hand washing is recommended to prevent the spread. The CDC recommends that individuals:

* "Wash hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing."
* "If soap and water are not readily available, use an alcohol-based hand sanitiser with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty."

The CDC, NHS, and WHO also advise individuals to avoid touching the eyes, nose, or mouth with unwashed hands.

### Respiratory hygiene

Those who suspect they are infected should wear a surgical mask (especially when in public) and call a doctor for medical advice. By limiting the volume and travel distance of expiratory droplets dispersed when talking, sneezing, and coughing, masks can serve a public health benefit in reducing transmission by those unknowingly infected.

If a mask is not available, anyone experiencing respiratory symptoms should cover a cough or sneeze with a tissue, promptly discard it in the trash, and wash their hands. If a tissue is unavailable, individuals can cover their mouth or nose with a flexed elbow.

Masks are also recommended for those taking care of someone who may have the disease. Rinsing the nose, gargling with mouthwash, and eating garlic are not effective.

There is no evidence to show that masks protect uninfected persons at low risk and wearing them may create a false sense of security. Surgical masks are widely used by healthy people in Hong Kong, Japan, Singapore and Malaysia. Surgical masks are not recommended by the CDC as a preventive measure for the American general public.

The WHO advises the following best practices for mask usage:

* Place mask carefully to cover mouth and nose and tie securely to minimise any gaps between the face and the mask; While in use, avoid touching the mask;
* Remove the mask by using appropriate technique (i.e. do not touch the front but remove the lace from behind);
* After removal or whenever you inadvertently touch a used mask, clean hands by using an alcohol-based hand rub or soap and water if visibly soiled
* Replace masks with a new clean, dry mask as soon as they become damp/humid;
* Do not re-use single-use masks; Discard single-use masks after each use and dispose of them immediately upon removal

Healthcare professionals interacting directly with people who have the disease are advised to use respirators at least as protective as NIOSH-certified N95, EU standard FFP2, or equivalent, in addition to other personal protective equipment.

### Quarantines

Main articles: 2020 Hubei lockdowns
On 23 January 2020, a quarantine on travel in and out of Wuhan was imposed in an effort to stop the spread of the virus out of Wuhan. Flights, trains, public buses, the metro system, and long-distance coaches were suspended indefinitely. Large-scale gatherings and group tours were also suspended. By 24 January 2020, a total of 15 cities in Hubei, including Wuhan, were placed under similar quarantine measures. On 27 and 28 January 2020, Xiangyang respectively closed its railway stations and suspended all ferry operations, after shutting down its airport and intercity bus services earlier. Thus, the entire Hubei province entered a city-by-city quarantine, save for the Shennongjia Forestry District.

Before the quarantine began, some in Wuhan questioned the reliability of the figures from the Chinese government as well as the government response, with some calling for quarantine, and a post also showed sick people and three dead bodies covered in white sheets on the floor of a hospital on 24 January, although many such posts in Weibo about the epidemic have since been deleted.

Due to quarantine measures, Wuhan residents rushed to stockpile essential goods, food, and fuel; prices rose significantly. 5,000,000 people left Wuhan, with 9,000,000 left in the city.

On 26 January, the city of Shantou in Guangdong declared a partial lockdown, though this was reversed two hours later. Residents had rushed to supermarkets to stock food as soon as the lockdown was declared, until the authorities reversed their decision. *Caixin* said, that the wording of Shantou's initial declaration was "unprecedentedly strict" and will severely affect residents' lives, if implemented as-is. Shantou's Department for Outbreak Control later clarified, that they will not restrict travelling, and all they would do, is to sterilise vehicles used for transportation.

Local authorities in Beijing and several other major cities, including Hangzhou, Guangzhou, Shanghai and Shenzhen announced on 26 January, that these cities will not impose a lockdown similar to those in Hubei province. Rumours of these potential lockdowns had spread widely prior to the official announcements. A spokesperson of Beijing's Municipal Transportation Commission claimed, that the expressways and highways, as well as subways and buses were operating normally. To ease the residents' panic, the Hangzhou city government stressed that the city would not be locked down from the outside world, and both cities said that they would introduce precautions against potential risks.

On 2 February 2020, the city of Wenzhou in Zhejiang province also implemented a partial lockdown, closing 46 of the 54 highway checkpoints.

On 4 February 2020, two more cities in Zhejiang province restricted the movement of residents. The city of Taizhou, three Hangzhou districts, and some in Ningbo began to only allow one person per household to go outside every two days to buy necessities, city officials said. More than 12 million people are affected by the new restrictions.

By 6 February 2020, a total of four Zhejiang cities -- Wenzhou, Hangzhou, Ningbo and Taizhou -- were under the "passport" system, allowing only one person per household to leave their home every two days. These restrictions apply to over 30 million people.

Outside Mainland China, some cruise ships were quarantined after passengers developed symptoms or tested positive for SARS-CoV-2. The *Costa Smeralda* was quarantined on 30 January off Civitavecchia in Italy, after passengers developed flu-like symptoms – the quarantine was lifted when tests for the virus came back negative. Two further ships were quarantined on 5 February: *Diamond Princess* in the Port of Yokohama, Japan and *World Dream*, which returned to Hong Kong after being refused entry to Kaohsiung, Taiwan. In both cases, passengers and crew tested positive. On 10 February passengers were allowed to disembark the *World Dream* "without the need to self-quarantine after leaving." The *Diamond Princess* remains quaratined with 136 confirmed cases as of 10 February. In addition, although not quarantined the MS Westerdam has been refused entry by several ports after departing Hong Kong on 1 February.

People queueing outside a Wuhan pharmacy to buy face masks and medical suppliesResidents of Wuhan wearing masks rushed out to nearby markets to buy vegetables and other food on 23 January during the outbreakResidents of Wuhan waiting for the last train of the city's metro on 10 am, 22 January
### Outdoor restrictions

On 1 February Huanggang, Hubei implemented a measure whereby only one person from each household is permitted to go outside for provisions once every two days, except for medical reasons or to work at shops or pharmacies. Many cities, districts, and counties across mainland China implemented similar measures in the days following, including Wenzhou, Hangzhou, Fuzhou, Harbin, and the whole of Jiangxi Province.

### Evacuation of foreign citizens

See also: Evacuations related to the 2019–20 coronavirus outbreak
Due to the effective lockdown of public transport in Wuhan and Hubei, several countries have planned to evacuate their citizens and diplomatic staff from the area, primarily through chartered flights of the home nation that have been provided clearance by Chinese authorities. Japan, India, the United States, France, Australia, Sri Lanka, Germany and Thailand were among the first to plan the evacuation of their citizens. Pakistan has said that it will not be evacuating any citizens from China. On 7 February, Brazil evacuated 34 Brazilians or family members in addition to four Poles, a Chinese and an Indian citizen. The citizens of Poland, China and India got off the plane in Poland, where the Brazilian plane made a stopover before following its route to Brazil. Brazilian citizens who went to Brazil were quarantined at a military base near Brasilia. A plane carrying 176 evacuees left Wuhan for Canada on 6 February, where they were to be quarantined at Canadian Forces Base Trenton in Ontario. Australian authorities evacuated 277 citizens on 3 and 4 February to the Christmas Island Detention Centre which had been "repurposed" as a quarantine facility, where they remained for 14 days. United States announced that it will evacuate Americans currently aboard the cruise ship Diamond Princess.

## Management

See also: 2019-nCoV acute respiratory disease#Management

As of 5 February 2020[update], there were no specific medications for or vaccines against 2019-nCoV, though development efforts were underway. Attempts to relieve the symptoms include taking regular (over-the-counter) flu medications, drinking fluids, and resting. Depending on the severity, oxygen therapy, intravenous fluids, and breathing support may be required. Some countries require people to report flu-like symptoms to their doctor, especially if they have visited mainland China.

### Domestic responses

The first person known to have fallen ill due to the new virus was in Wuhan on 1 December 2019. A public notice on the outbreak was released 30 days later by Wuhan health authority on 31 December 2019; the initial notice informed Wuhan residents that there was no clear evidence of human-to-human transmission of the virus, that the disease is preventable and controllable, and that people can wear masks when going out. WHO was informed of the outbreak on the same day.

On 20 January 2020, Zhong Nanshan, a scientist at China's National Health Commission who played a prominent role in the SARS epidemic declared its potential for human-to-human transmission, after 2 cases emerged in Guangdong province of infection by family members who had visited Wuhan. This was later confirmed by the Wuhan government, which announced a number of new measures such as cancelling the Chinese New Year celebrations, in addition to measures such as checking the temperature of passengers at transport terminals first introduced on 14 January. A quarantine was announced on 23 January 2020 stopping travel in and out of Wuhan.

On 25 January, Politburo of the Communist Party of China met to discuss novel coronavirus prevention and control. Chinese Communist Party general secretary Xi Jinping stated that the country is facing a "grave situation" as the number of infected people is accelerating. In the evening, the authorities banned the use of private vehicles in Wuhan. Only vehicles that are transporting critical supplies or emergency response vehicles are allowed to move within the city.

On 26 January, a leading group tasked with the prevention and control of the novel coronavirus outbreak was established, led by Chinese Premier Li Keqiang. Premier Li visited Wuhan to direct the epidemic prevention work on 27 January. The leading group has decided to extend Spring Festival holiday to contain coronavirus outbreak.

China Customs started requiring that all passengers entering and exiting China fill in an extra health declaration form from 26 January. The health declaration form was mentioned in China's Frontier Health and Quarantine Law, granting the customs rights to require it if needed. The customs said it will "restart this system" as it was not a requirement before.

On 27 January, the General Office of the State Council of China, one of the top governing bodies of the People's Republic, officially declared a nation-wide extension on the New Year holiday and the postponement of the coming spring semester. The Office extended the previously scheduled public holiday from 30 January to 2 February, while it said school openings for the spring semester will be announced in the future. Some universities with open campuses also banned the public from visiting. On 23 January, the education department in Hunan, which neighbours the centre of the outbreak Hubei province, stated it will strictly ban off-school tutors and restrict student gatherings. Education departments in Shanghai and Shenzhen also imposed bans on off-school tutoring and requested that schools track and report students who had been to Wuhan or Hubei province during the winter break. The semi-autonomous regions of Hong Kong and Macau also announced adjustments on schooling schedules. Hong Kong's Chief Executive Carrie Lam declared an emergency at a press conference on 25 January, saying the government will close primary and secondary schools for two more weeks on top of the previously scheduled New Year holiday, pushing the date for school reopening to 17 February. Macau closed several museums and libraries, and prolonged the New Year holiday break to 11 February for higher education institutions and 10 February for others. The University of Macau said they would track the physical conditions of students who have been to Wuhan during the New Year break.

After the Chinese New Year on 25 January, there would be another peak of people travelling back from their hometowns to workplaces as a part of Chunyun. Several provinces and cities encouraged people to stay in their hometowns and not travel back. Eastern China's Suzhou also encouraged remote working via the Internet and further prolonged the spring festival break.

The Civil Aviation Administration of China and the China State Railway Group, which regulates China's civil aviation and operates rail services, announced on 24 January that passengers could have full refunds for their plane and train tickets without any additional surcharges, regardless of whether their flight or train will go through Wuhan or not. Some hotel chains and online travel agencies also allowed more flexibility in cancellations and changes. China's Ministry of Culture and Tourism ordered travel agencies and online tourism firms to suspend package tours and stop offering "flight+hotel" bundles.

Additional provinces and cities outside of Hubei imposed travel restrictions. Beijing suspended all intercity bus services on 25 January, with several others following suit. Shanghai, Tianjin, Shandong, Xi'an, and Sanya all announced suspension of intercity or inter-province bus services on 26 January.

On 1 February 2020, Xinhua News reported that China's Supreme People's Procuratorate (SPP) has "asked procuratorates nationwide to fully play their role to create a favourable judicial environment in the fight against the novel coronavirus outbreak." This includes severe punishments for those found guilty of dereliction of duty and the withholding of information for officials. Tougher charges were proscribed for commercial criminal activities such as "the pushing up of prices, profiteering and severely disturbing market order" along with the "production and sale of fake and shoddy protective equipment and medicines." Prosecuting actions against patients who deliberately spread the infection or refuse examination or compulsory isolation along with threats of violence against medical personnel were also urged. The statement also included urging to prosecute those found "fabricating coronavirus-related information that may lead to panic among the public, making up and spreading rumors about the virus, sabotaging the implementation of the law and endangering public security" and also stressed harsh punishment for the illegal hunting of wildlife under state protection, as well as improving inspection and quarantine measures for fresh food and meat products."

Museums throughout China are temporarily closed. To provide cultural and heritage seekers some form of service, the Chinese Nation Cultural Heritage Administration (NCHA) has asked museums around the country to move their exhibits and galleries temporarily online. This is done via a specific program that the NCHA is launching. Some museums are also putting the content on their own website, social media, or even social chat apps and rooms like WeChat. The majority of the content will be available on a NCHA website web page, however it is only accessible inside of China. However, there are a few excerpts from the main created exhibition website that are on the NCHA general information page that are linked too, that are accessible outside of China.

#### Interprovincial medical aid

As of 16 February 217 teams of a total of 25,633 medical workers from across China went to Wuhan and other cities in Hubei to help open up more facilities and treat patients.

#### Censorship and police responses

The first known infection by a new virus was reported in Wuhan on 1 December 2019. The early response by city authorities was accused of prioritising a control of information on the outbreak. A group of eight medical personnel, including Li Wenliang, an ophthalmologist from Wuhan Central Hospital, who in late December posted warnings on a new coronavirus strain akin to SARS, were warned by Wuhan police for "spreading rumours" for likening it to SARS.

By the time China had informed the World Health Organization of the new coronavirus on 31 December 2019, after allegations of using its influence within the WHO to downplay the epidemic until it became unchecked, the *New York Times* reported that the government was still keeping "its own citizens in the dark". While by a number of measures, China's initial handling of the crisis was an improvement in relation to the SARS response in 2003, China has been criticised for cover-ups and downplaying the initial discovery and severity of the outbreak. This has been attributed to the censorship modus operandi of the country's press and internet, with the *New York Times* Nicholas Kristof and CSIS's Jude Blanchette suggesting that it was exacerbated by China's paramount leader Xi Jinping's crackdown on independent oversight such as journalism and social media that left senior officials with inaccurate information on the outbreak and "contributed to a prolonged period of inaction that allowed the virus to spread".

On 20 January, General Secretary Xi Jinping made his first public remark on the outbreak and spoke of "the need for the timely release of information". Chinese premier Li Keqiang also urged efforts to prevent and control the epidemic. One day later, the CPC Central Political and Legal Affairs Commission, the most powerful political organ in China overseeing legal enforcement and the police, wrote "self-deception will only make the epidemic worse and turn a natural disaster that was controllable into a man-made disaster at great cost," and "only openness can minimise panic to the greatest extent." The commission then added, "anyone who deliberately delays and hides the reporting of cases out of self-interest will be nailed on a pillar of shame for eternity." Also on the same day, Xi Jinping instructed authorities "to strengthen the guidance of public opinions", language which some view as a call for censorship after commentators on social media became increasingly pointedly critical and angry at the government due to the epidemic. Some view this as contradictory to the calls for "openness" that the central government had already declared.

Top official Zhang Xiaoguo said that his department would "treat propaganda regarding the control and prevention measures of the virus as its top priority", while a statement on Xi Jinping on 3 February declared the need for an emphasis by state media on "telling the moving stories of how [people] on the front line are preventing and fighting the virus" as a priority of coverage. The state media has been observed to be publishing effusive praise on Beijing's response to the epidemic, such as extensive coverage of the new hospital under construction in Wuhan, the lock down of Wuhan with its population of 11 million, and the "unprecedented" quarantine of Hubei province. The *Financial Times* noted that such widely publicised actions made a strong impression upon domestic and international observers that the "overbearing, centralized government" of China was particularly suited to dealing with the crisis, despite the fact that the lock down of Wuhan came too late to be effective as millions had left. Steve Tsang, director of the China Institute at SOAS University of London, observed that the media was hyping Beijing's heightened response to the outbreak as if Xi Jinping had directly intervened.

As part of the central government's "bifurcated approach to diffuse discontent", while the propaganda machinery was going into "overdrive...to protect [Xi Jinping's] reputation", citizens were permitted to criticise local officials so long as they did not "question the basic legitimacy of the party". The Cyberspace Administration (CAC) declared its intent to foster an "good online atmosphere," with CAC notices sent to video platforms encouraging them to "not to push any negative story, and not to conduct non-official livestreaming on the virus." Censorship has been observed being applied on news articles and social media posts deemed to hold negative tones about the coronavirus and the governmental response, including posts mocking Xi Jinping for not visiting areas of the epidemic, an article that predicted negative effects of the epidemic on the economy, and calls to remove local government officials. Chinese citizens have reportedly used innovative methods to avoid censorship to express anger about how government officials have handled the initial outbreak response, such as using the word 'Trump' to refer to Xi Jinping, or 'Chernobyl' to refer to the outbreak as a whole. While censorship had been briefly relaxed giving a "window of about two weeks in which Chinese journalists were able to publish hard-hitting stories exposing the mishandling of the novel coronavirus by officials", since then private news outlets were reportedly required to use "planned and controlled publicity" with the authorities' consent. Reports have described how police have detained people for online posts critical of authorities' response to the epidemic, with a case on 25 January in Tianjin where a man was detained for 10 days for "maliciously publishing aggressive, insulting speech against medical personnel".

On 30 January, China's Supreme Court, delivered a rare rebuke against the country's police forces, calling the "unreasonably harsh crackdown on online rumours" as undermining public trust. In what has been called a "highly unusual criticism" by observers, supreme court judge Tang Xinghua said that if police had been lenient against rumours and allowed the public to have taken heed of them, an earlier adoption of "measures like wearing masks, strictly disinfecting and avoiding wildlife markets" might have been useful in countering the spread of the epidemic. The Human Rights Watch stated that "there is considerable misinformation on Chinese social media and authorities have legitimate reasons to counter false information that can cause public panic," but also noted censorship by the authorities on social media posted by families of infected people who were potentially seeking help as well as by people living in cordoned cities who were documenting their daily lives amidst the lockdown.

After the death of Li Wenliang, who was widely hailed as a whistleblower in China on 7 February, some of the trending hashtags on Weibo such as "Wuhan government owes Dr Li Wenliang an apology" and "We want freedom of speech" were blocked. While media outlets were allowed to report his death, the nature of the doctor's censorship which produced widespread public anger in the aftermath, in what has been described as "one of the biggest outpourings of online criticism of the government in years," was not a topic that was permitted for coverage. One such media outlet even sending notices to editors, and leaked to reporters, asking them to refrain from "commenting or speculating" and giving instructions to "not hashtag and let the topic gradually die out from the hot search list, and guard against harmful information." After attempts to discourage the discussion on Dr. Li's death further escalated online anger, the central government has reportedly attempted to reshape the narrative by "cast[ing] Dr. Li’s death as the nation’s sacrifice — meaning, the Chinese Communist Party’s own". A group of Chinese academics including Xu Zhangrun of Tsinghua University signed an open letter calling for the central government to issue an apology to Dr. Li and to protect freedom of speech. Professor Zhou Lian of Renmin University has observed that the epidemic has “allowed more people to see the institutional factors behind the outbreak and the importance of freedom of speech”.

### International responses

See also: Timeline of the 2019–20 coronavirus outbreak in December 2019 – January 2020#Reactions and measures outside Mainland China, Timeline of the 2019–20 coronavirus outbreak in February 2020#Reactions and measures outside Mainland China

Since 31 December 2019, some regions and countries near China tightened their screening of selected travellers. The Centers for Disease Control and Prevention (CDC) of the United States later issued a Level 1 travel watch. Guidances and risk assessments were shortly posted by others including the European Centre for Disease Prevention and Control and Public Health England. In China, airports, railway stations and coach stations installed infrared thermometers. Travellers with a measured fever are taken to medical institutions after being registered and given masks. Real time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR) test was used to confirm new cases of coronavirus infection.

An analysis of air travel patterns was used to map out and predict patterns of spread and was published in the *Journal of Travel Medicine* in mid-January 2020. Based on information from the International Air Transport Association (2018), Bangkok, Hong Kong, Tokyo, and Taipei had the largest volume of travellers from Wuhan. Dubai, Sydney and Melbourne were also reported as popular destinations for people travelling from Wuhan. Using the validated tool, the Infectious Disease Vulnerability Index (IDVI), to assess the ability to manage a disease threat, Bali was reported as least able in preparedness, while cities in Australia were considered most able.

As a result of the outbreak many countries including most of the Schengen area, Armenia, Australia, India, Iraq, Indonesia, Kazakhstan, Kuwait, Malaysia, Maldives, New Zealand, Philippines, Singapore, Sri Lanka, Taiwan, Vietnam and the United States have imposed temporary entry bans on Chinese citizens or recent visitors to China, or have ceased issuing visas and reimposed visa requirements on Chinese citizens. Samoa even started refusing entry to its own citizens who had previously been to China, attracting widespread condemnation over the legality of such decision.

In Asia, Hong Kong, Mongolia, Nepal, North Korea, Russia and Vietnam have also responded with border tightening/closures with mainland China. On 22 January 2020, North Korea closed its borders to international tourists to prevent the spread of the virus into the country. Chinese visitors make up the bulk of foreign tourists to North Korea.

Also on 22 January, the Asian Football Confederation (AFC) announced that it would be moving the matches in the third round of the 2020 AFC Women's Olympic Qualifying Tournament from Wuhan to Nanjing, affecting the women's national team squads from Australia, China PR, Chinese Taipei and Thailand. A few days later, the AFC announced that together with Football Federation Australia they would be moving the matches to Sydney. The Asia-Pacific Olympic boxing qualifiers, which were originally set to be held in Wuhan from 3–14 February, were also cancelled and moved to Amman, Jordan to be held between 3–11 March.

On 27 January 2020, the United States CDC issued updated travel guidance for China, recommending that travellers avoid all nonessential travel to all of the country. The CDC has directed US Customs and Border Protection to check individuals for symptoms of the coronavirus.

On 29 January 2020, British Airways, Lufthansa, Lion Air, and Air Seoul cancelled all their flights to mainland China in reaction to the spread of the virus. The same day, the Czech Republic stopped issuing Schengen visas to Chinese citizens.

On 30 January 2020, Belgium, Greece and Italy closed all Schengen Visa application centres in China. The same day, Egyptair announced suspension of flights between Egypt and Hangzhou starting 1 February 2020 while those to Beijing and Guangzhou will be suspended starting 4 February 2020 until further notice.

On 31 January 2020, Italy closed all passenger air traffic between Italy and China and Taiwan. The Italian Civil Aviation Authority NOTAM says that effective 31 January, all passenger flights from China, including the special administrative regions of Hong Kong and Macau, and Taiwan are suspended until further notice, on request of the Italian health authorities. Aircraft that were flying to Italy when the NOTAM was published, were cleared to land.

As of 1 February 2020, France was the only remaining Schengen country still issuing visas to Chinese citizens.

Qatar Airways took the decision to suspend flights to mainland China from 3 February until further notice, due to significant operational challenges caused by entry restrictions imposed by several countries. Qatar Airways is the first carrier in the Middle East to do so. An ongoing review of operations will be conducted weekly with the intention to reinstate flights as soon as the restrictions are lifted.

Though some of the airlines cancelled flights to Hong Kong as well, British Airways, Finnair and Lufthansa have not, and American Airlines continues operating a limited service to the area. Hong Kong's four airlines halved the flights to mainland China. A large number of airlines have reduced or cancelled flights to and from China. On 31 January 2020, the United States declared the virus a public health emergency. Starting 2 February, all inbound passengers who have been to Hubei in the previous 14 days will be put under quarantine for up to 14 days. Any US citizen who has travelled to the rest of mainland China will be allowed to continue their travel home if they are asymptomatic, but will be monitored by local health departments.

On 2 February 2020, India issued a travel advisory that warned all people residing in India to not travel to China, suspended E-visas from China, and further stated anyone who has travelled to China starting 15 January (to an indefinite point in the future) could be quarantined. New Zealand announced that it will deny entry to all travellers from China and that it will order its citizens to self-isolate for 14 days if they are returning from China. Indonesia and Iraq followed by also banning all travellers that visited China within the past 14 days.

On 3 February 2020, Indonesia announced it would ban passenger flights and also sea freight from and to China starting on 5 February and until further notice. Live animal imports and other products were banned as well. Minister of Trade Agus Suparmanto "We will obviously stop live animals imports from China and are still considering banning other products" Turkey announced it would suspend all flights from China till the end of February and begin scanning passengers coming from South Asian countries at airports.

#### International aid

On 5 February, the Chinese foreign ministry stated that 21 countries (including Belarus, Pakistan, Trinadad and Tobago, Egypt, and Iran) had sent aid to China.

 File:Digital billboard in Shibuya expressing support against coronavirus.jpg
The United States city of Pittsburgh announced plans to promptly send aid to Wuhan, with mayor Bill Peduto stating that "Our office has reached out to the mayor of Wuhan, which is our sister city" and promising that "over the next two days we should be able to have a care package that has been put together." He speculated that the contents of such a package will be coordinated with the consultation of medical experts, but that it will likely consist of "face masks, rubber gloves and other material that could be hard to find in the future". Additionally, the University of Pittsburgh Medical Center (UPMC) announced plans to provide help, with UPMC spokesman Paul Wood stating that "UPMC has a significant presence in China and has been in contact with our partners there", also declaring that "we stand ready to assist them and others in China with their unmet humanitarian needs." Some Chinese students at other American universities have also joined together to help send aid to virus-stricken parts of China, with a joint group in the Greater Chicago Area reportedly managing to send 50,000 N95 masks and 1,500 protection suits to hospitals in the Hubei province on 30 January.

The humanitarian aid organisation Direct Relief, in co-ordination with FedEx transportation and logistics support, sent 200,000 face masks along with other personal protective equipment, including gloves and gowns, by emergency airlift to arrive in Wuhan Union Hospital, who requested the supplies by 30 January. The Gates Foundation stated on 26 January that it would donate US$5 million in aid to support the response in China that will be aimed at assisting "emergency funds and corresponding technical support to help front-line responders".

Japan, in the process of co-ordinating a plane flight to Wuhan to pick up Japanese nationals in the city, has promised that the plane will first carry into Wuhan aid supplies that Japanese foreign minister Toshimitsu Motegi stated will consist of "masks and protective suits for Chinese people as well as for Japanese nationals". On 26 January, the plane arrived in Wuhan, donating its supply of one million face masks to the city. Also among the aid supplies were 20,000 protective suits for medical staff across Hubei donated by the Tokyo Metropolitan Government.

Support efforts have sprung across Japan to help aid residents in Wuhan. On 27 January, the city of Ōita, a sister city to Wuhan for 40 years, sent 30,000 masks from its own disaster relief stockpile to its sister city through the Red Cross network with boxes labelled "Wuhan Jiayou!", meaning "Hang in there, Wuhan!" in Chinese. Its International Affairs Office division head, Soichiro Hayashi, said that "The people of Wuhan are like family" and expressed hopes that "people can return to their ordinary lives as quickly as possible".

On 28 January, the city of Mito donated 50,000 masks to its sister-city of Chongqing, and on 6 February, the city of Okayama sent 22,000 masks to Luoyang, its own sister-city. The ruling Liberal Democratic Party on 10 February made a symbolic deduction of 5,000 yen from the March salary of every LDP parliamentarian, a total of 2 million yen, to donate to China, with the party's secretary-general, Toshihiro Nikai, stating that "For Japan, when it sees a virus outbreak in China, it is like seeing a relative or neighbour suffering. Japanese people are willing to help China and hope the outbreak will pass as soon as possible."

Peace Winds Japan has declared it will send a staff member to China to help distribute the face masks and other goods that the NGO will send to the country.

A number of other countries have also announced aid efforts. Malaysia announced a donation of 18 million medical gloves to China, The Philippine Red Cross also donated $1.4 million worth of Philippine-made face masks, which were shipped to Wuhan. Turkey dispatched medical equipment, and Germany delivered various medical supplies including 10,000 Hazmat suits.

### Speciality hospitals

 File:Wuhan Jinyintan Hospital (retouched).jpg

A speciality hospital named Huoshenshan Hospital has been constructed as a countermeasure against the outbreak and to better quarantine the patients. Wuhan City government had demanded that a state-owned enterprise construct such a hospital "at the fastest speed" comparable to that of the SARS outbreak in 2003. On 24 January, Wuhan authorities specified its planning, saying they planned to have Huoshenshan Hospital built within six days of the announcement and it will be ready to use on 3 February. Upon opening, the speciality hospital has 1,000 beds and takes up 30,000 square metres. The hospital is modelled after the Xiaotangshan Hospital (zh), which was fabricated for the SARS outbreak of 2003, itself built in only seven days. State media reported that there were 7,000 workers and nearly 300 units of construction machinery on the site at peak.

On 25 January authorities announced plans for Leishenshan Hospital, a second speciality hospital, with a capacity of 1,600 beds; operations are scheduled to start by 6 February. Some people voiced their concerns through social media services, saying the authorities' decision to build yet another hospital in such little time showed the severity of the outbreak could be a lot worse than expected.

On 24 January 2020, the authority announced that they would convert an empty building in Huangzhou District, Huanggang to a 1,000-bed hospital named Dabie Mountain Regional Medical Centre. Works began the next day by 500 personnel and the building began accepting patients on 28 January 2020 at 10:30 pm.

In Wuhan, authorities have seized dormitories, offices and hospitals to create more beds for patients.

## Reactions to prevention efforts

### WHO response

The World Health Organization (WHO) has commended the efforts of Chinese authorities in managing and containing the epidemic, with Director-General Tedros Adhanom Ghebreyesus expressing "confidence in China's approach to controlling the epidemic" and calling for the public to "remain calm". The WHO noted the contrast between the 2003 epidemic, where Chinese authorities were accused of secrecy that impeded prevention and containment efforts, and the current crisis where the central government "has provided regular updates to avoid panic ahead of Lunar New Year holidays".

In reaction to the central authorities' decision to implement a transportation ban in Wuhan, WHO representative Gauden Galea remarked that while it was "certainly not a recommendation the WHO has made", it was also "a very important indication of the commitment to contain the epidemic in the place where it is most concentrated" and called it "unprecedented in public health history". Unlike the recommendations of other agencies, Tedros stated that "there is no reason for measures that unnecessarily interfere with international travel and trade" and that "WHO doesn't recommend limiting trade and movement". Alexandra Phelan of Georgetown University said that the lockdown "should be called out, both for their human rights implication and their very limited public health impact" but reasoned that Tedros would dare not speak out in order to ensure China's co-operation.

On 30 January 2020, following confirmation of human-to-human transmission outside of China and the increase in number of cases in other countries, the WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC), the sixth PHEIC since the measure was first invoked during the 2009 swine flu pandemic. Tedros clarified that the PHEIC, in this case, was "not a vote of no confidence in China", but because of the risk of global spread, especially to low- and middle-income countries without robust health systems.

The WHO and Chinese authorities have also received criticism for their handling of the epidemic. John Mackenzie of the WHO's emergency committee and Anne Schuchat of the Centers for Disease Control and Prevention in Washington suggested that China's official tally of cases and deaths was an underestimation, while others noted that China lumped Taiwan with the semi-autonomous regions of Hong Kong and Macao when reporting outbreak data. An unnamed United Nations diplomat said that the "World Health Organization is so much in thrall to China's influence, they have felt compelled to stay close to China's line on this crisis...to downplay this virus...until its position became untenable". Taiwan, for refusing the adhere to the "One China" policy, was only granted participation at the WHO for this outbreak after "lobbying by countries including the U.S." Some attacked WHO director-general Tedros for his apparent appeasement to avoid "antagoniz[ing] the notoriously touchy Chinese government", however others defended this strategy in order "to ensure Beijing’s co-operation in mounting an effective global response to the outbreak", leading to further criticism that such a stance "puts [the] WHO’s moral authority at risk". Tedros also drew criticism for delaying the declaration that the outbreak was a global emergency, leaving to an online petition calling for his resignation.

### International reactions

China's response to the virus, in comparison to the 2003 SARS outbreak, has been praised by some foreign leaders. US president Donald Trump thanked Chinese President Xi Jinping "on behalf of the American People" on 24 January 2020 on Twitter, stating that "China has been working very hard to contain the Coronavirus. The United States greatly appreciates their efforts and transparency" and declaring that "It will all work out well." Germany's health minister Jens Spahn, in an interview on Bloomberg TV, said with comparison to the Chinese response to SARS in 2003: "There's a big difference to SARS. We have a much more transparent China. The action of China is much more effective in the first days already." He also praised the international co-operation and communication in dealing with the virus.

At a Sunday mass at St. Peter's Square in Vatican City on 26 January 2020, Pope Francis praised "the great commitment by the Chinese community that has already been put in place to combat the epidemic" and commenced a closing prayer for "the people who are sick because of the virus that has spread through China".

### Criticism of local response

Local officials in Wuhan and the province of Hubei have faced criticism, both domestically and internationally, for mishandling the initial outbreak. Allegations included insufficient medical supplies, lack of transparency to the press and censorship of social media during the initial weeks of the outbreak. On 1 January 2020, the Wuhan police interviewed eight residents for "spreading false information" (characterising the new infection as SARS-like). The Wuhan police had originally stated through a post on its official Weibo account that "eight people had been dealt with according to the law", later clarifying through Weibo that they had only given out "education and criticism" and refrained from harsher punishments such as "warnings, fines, or detention". One of the eight, a doctor named Li Wenliang who informed his former medical school classmates of the coronavirus in a WeChat group after examining a patient's medical report with symptoms of the illness, was warned by the police on 3 January for "making untrue comments" that had "severely disturbed the social order" and made to sign a statement of acknowledgment. It was reported on 7 February 2020 Li had died after contracting the disease from a patient in January 2020. His death triggered grief and anger on the social media, which became extended to demands for freedom of speech in China. China's anti-corruption body, the National Supervisory Commission, has initiated an investigation into the issues involving Li.

Local officials were criticised for hiding evidence of human-to-human transmission in early January, and suppressing reports about the disease during People's Congress meetings for political reasons. Criticism was directed at Hubei Governor Wang Xiaodong after he twice claimed at a press conference that 10.8 billion face masks were produced each year in the province, rather than the accurate number of 1.8 million.

Wuhan Police detained several Hong Kong media correspondents for over an hour when they were conducting interviews at Wuhan's Jinyintan Hospital on 14 January. Reports said the police brought the correspondents to a police station, where the police checked their travel documents and belongings, then asked them to delete video footage taken in the hospital before releasing them.

Authorities in Wuhan and Hubei provinces have been criticised for downplaying the severity of the outbreak and responding slower than they could have. The Beijing-based media journal, *Caixin* noted that Hubei did not roll out the first level of "public health emergency response mechanism" until 24 January, while several other provinces and cities outside of the centre of the outbreak have already done so the day before. John Mackenzie, a senior expert at WHO, accused them of keeping "the figures quiet for a while because of some major meeting they had in Wuhan", alleging that there was a "period of very poor reporting, or very poor communication" in early January.

On 19 January, four days before the city's lockdown, a *wan jia yan* (Chinese: 万家宴; literally "ten-thousand family banquet") was held in Wuhan, with over 40,000 families turning out; this attracted retrospective criticism. The domestic *The Beijing News* argued that the local authorities should not have held such a public assembly while attempting to control the outbreak. The paper also stated that when their journalists visited the Huanan Seafood Wholesale Market where the coronavirus likely originated, most residents and merchants there were not wearing face masks. Zhou Xianwang, the mayor of Wuhan, later spoke to China Central Television, explaining that the banquet was held annually, that it is a "sample of the people's self-autonomy", and that the decision was made based on the fact that scientists then wrongly believed that the virus's ability to spread between humans was limited. Meanwhile, on 20 January, Wuhan's municipal department for culture and tourism gave out 200,000 tickets valid for visiting all tourist attractions in Wuhan to its citizens for free. The department was later criticised for disregarding the outbreak.

In contrast to the widespread criticism of the local response, the central government has been praised by international experts for its handling of the crisis, and especially by state media. This has led to suggestions, in particular by the international media, that it is an attempt by the official press to shift public anger away from the central government and towards local authorities. It has been noted historically that the tendency of provincial governments to minimise reporting local incidents have been because of the central government directing a large proportion of the blame onto them. Critics, such as Wu Qiang, a former professor at Tsinghua University, and Steve Tsang, director of the China Institute at the University of London, have further argued the same point, with the latter suggesting that it was also exacerbated through local officials being "apprehensive about taking sensible preventive measures without knowing what Xi and other top leaders wanted as they feared that any missteps would have serious political consequences", a sentiment that Tsang argued was difficult to avoid when "power is concentrated in the hands of one top leader who is punitive to those who make mistakes". Wuhan mayor Zhou Xianwang defended himself, referring to those suggestions by publicly blaming regulatory requirements that require local governments to first seek Beijing's approval, which delayed disclosure of the epidemic. He stated in an interview that "as a local government, we may disclose information only after we are given permission to do so. That is something that many people do not understand." The Chinese government has also been accused of rejecting help from the CDC and WHO.

Tang Zhihong, the chief of the health department in Huanggang, was fired hours after she was unable to answer questions on how many people in her city were being treated.

### Misinformation

Main articles: Misinformation related to the 2019–20 coronavirus outbreak
After the initial outbreak, conspiracy theories and misinformation spread online regarding the origin and scale of the Wuhan coronavirus. Various social media posts claimed the virus was a bio-weapon, a population control scheme, or the result of a spy operation. Google, Facebook, and Twitter announced they will crack down on possible misinformation. In a blogpost, Facebook stated they would remove content flagged by leading global health organisations and local authorities that violate its content policy on misinformation leading to "physical harm".

On 2 February, the WHO declared there was a "massive infodemic" accompanying the outbreak and response, citing an over-abundance of reported information, accurate and false, about the virus that "makes it hard for people to find trustworthy sources and reliable guidance when they need it." The WHO stated that the high demand for timely and trustworthy information has incentivised the creation of a direct WHO 24/7 myth-busting hotline where its communication and social media teams have been monitoring and responding to misinformation through its website and social media pages.

### Xenophobia and racism-related incidents

Main articles: Xenophobia and racism related to the 2019–20 coronavirus outbreak
Since the outbreak of COVID-19, which originated in the city of Wuhan in Hubei, China, heightened prejudice, xenophobia and racism against peoples of Chinese and East Asian descent having been observed to have arisen as a result, with incidents of fear, suspicion and hostility being noted across various countries. And although there has been support from Chinese both on and offline towards those in virus-stricken areas, many residents of Wuhan and Hubei have reported experiencing discrimination based on their regional origin.

On 30 January, WHO's Emergency Committee issued a statement advising all countries to be mindful of the "principles of Article 3 of the IHR," which cautions against "actions that promote stigma or discrimination," when conducting national response measures to the outbreak.

### Open access of scientific papers

Owing to the urgency of the epidemic, many scientific publishers have made scientific papers related to the outbreak open access. Some scientists have chosen to share their results quickly on preprint servers such as BioRxiv, while archivists have created an illegal open access database of over 5,000 papers.

## Socio-economic impact

The epidemic coincided with the Chunyun, a major travel season associated with the Chinese New Year holiday. A number of events involving large crowds were cancelled by national and regional governments, including annual New Year festivals, with private companies also independently closing their shops and tourist attractions such as Hong Kong Disneyland and Shanghai Disneyland. Many Lunar New Year events and tourist attractions have been closed to prevent mass gatherings, including the Forbidden City in Beijing and traditional temple fairs. In 24 of China's 31 provinces, municipalities and regions, authorities extended the New Year's holiday to 10 February, instructing most workplaces not to re-open until that date. These regions represented 80% of the country's GDP and 90% of exports. Hong Kong raised its infectious disease response level to the highest and declared an emergency, closing schools until March and cancelling its New Year celebrations.

As Mainland China is a major economy and a manufacturing hub, the viral outbreak has been seen to pose 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. Some analysts have estimated that the economic fallout of the epidemic on global growth could surpass that of the SARS outbreak. Dr. Panos Kouvelis, director of "The Boeing Center" at Washington University in St. Louis, estimates a $300+ billion impact on world's supply chain that could last up to two years. Organization of the Petroleum Exporting Countries reportedly "scrambled" after a steep decline in oil prices due to lower demand from China.

The demand for personal protection equipment has risen 100-fold, according to WHO director-general Tedros Adhanom. This demand has lead to the increase in prices of up to twenty times the normal price and also induced delays on the supply of medical items for four to six months.

### Mainland China

Main articles: Mainland China during the 2019–20 coronavirus outbreak
Tourism in China has been hit hard by travel restrictions and fears of contagion, including a ban on both domestic and international tour groups. Many airlines have either cancelled or greatly reduced flights to China and several travel advisories now warn against travel to China. Many countries, including France, Japan, the United Kingdom and the United States, have evacuated their nationals from the Wuhan and Hubei provinces.

The majority of schools and universities have extended their annual holidays to mid-February. Overseas students enrolled at Chinese universities have been returning home over fears of being infected—the first cases to be reported by Nepal and Kerala, a southern state of India, were both of students who had returned home.

The Finance Ministry of China announced it would fully subsidise personal medical cost incurred by patients.

CNN reported that some people from Wuhan "have become outcasts in their own country, shunned by hotels, neighbors and – in some areas – placed under controversial quarantine measures." Ian Lipkin, a Columbia-based epidemiologist advising the Chinese authorities on handling the outbreak, opined that the barricades and signs forbidden entry to people from Wuhan as well as neighborhood tips leading to involuntary quarantine were "probably" necessary due to the lack of other viable options.

### Australia

Australia is expected to be one of three economies worst affected by the epidemic, along with Mainland China and Hong Kong. Early estimations have GDP contracting by 0.2% to 0.5% and more than 20,000 Australian jobs being lost. The Australian Treasurer said that the country would no longer be able to promise a budget surplus due to the outbreak. The Australian dollar dropped to its lowest value since the Great Recession.

The Australasian College for Emergency Medicine called for a calm and a fact-based response to the epidemic, asking people to avoid racism, "panic and division" and the spread of misinformation. A large amount of protective face masks were purchased by foreign and domestic buyers, which has sparked a nationwide face masks shortage. In response to price increases of nearly 2000%, the Pharmaceutical Society of Australia has called on these "unethical suppliers" to keep supplies affordable.

Tourism bodies have suggested that the total economic cost to the sector, as of 11 February 2020, would be A$4.5bn. Casino earnings are expected to fall. At least two localities in Australia, Cairns and the Gold Coast, have reported already lost earnings of more that $600 million. The Australian Tourism Industry Council (ATIC) called on the Government of Australia for financial support especially in light of the large number of small businesses affected.

Mining companies are thought to be highly exposed to the outbreak, since sales to China constitute 93% of the sales of Fortescue Metals, 55% of the sales of BHP, and 45% of the sales of Rio Tinto. The iron ore shipping gauge dropped 99.9% as a result of the outbreak, and the virus has made shipping and logistic operations of mining companies more complicated.

Agriculture is also experiencing negative effects from the outbreak, including the Australian dairy industry, fishing industry, wine producers, and meat producers. On 13 February 2020 Rabobank, which specialises in agricultural banking, warned that the agricultural sector had eight weeks for the coronavirus to be contained before facing major losses.

The education sector is expected to suffer a US$5 billion loss according to an early government estimate, including costs due to "tuition fee refunds, free deferral of study, realignment of teaching calendars and student accommodation costs." The taxpayer is likely to be required to cover the shortfall in education budgets. An estimated 100,000 students were not able to enroll at the start of the semester. Nearly two-thirds of Chinese students were forced to remain overseas due to visa restrictions on travellers from Mainland China. Salvatore Babones, associate professor at the University of Sydney, stated that "Australia will remain an attractive study destination for Chinese students, but it may take several years for Chinese student numbers to recover".

### Brazil

Two Brazilian banks predicted the deceleration of economic growth in China. UBS has reviewed its estimations from 6% to 5.4%, while Itaú stated a reduction to 5.8%.

A representative of some of the bigger Brazilian companies of the electronics sector, Eletros, stated that the current stock for the supply of components is enough for around 10 to 15 days.

The prices of soy-beans, oil and iron ore have been falling. These three goods represent 30%, 24% and 21% of the Brazilian exports to China, respectively.

### Europe

In the United Kingdom, digger manufacturer JCB announced that it plans to reduce working hours and production due to shortages in their supply chain caused by the outbreak.

In Spain, a large number of exhibitors (including Chinese firms Huawei and Vivo) announced plans to pull out of or reduce their presence at Mobile World Congress, a wireless industry trade show in Barcelona, Spain, due to concerns over coronavirus. On 12 February 2020, GSMA CEO John Hoffman announced that the event had been cancelled, as the concerns had made it "impossible" to host.

In Germany, according to the Deutsche Bank the outbreak of the novel coronavirus may contribute to a recession in Germany.

Owing to an increase in the demand for masks, on 1 February most masks were sold out in Portuguese pharmacies. On 4 February, President Marcelo Rebelo de Sousa admitted that the epidemic of the new coronavirus in China "affects the economic activity of a very powerful economy and thus affects the world's economic activity or could affect". He also admitted the possibility of economic upheavals due to the break in production."

### Japan

Prime Minister Shinzō Abe has said that "the new coronavirus is having a major impact on tourism, the economy and our society as a whole". Face masks have sold out across the nation and stocks of face masks are depleted within a day of new arrivals. There has been pressure placed on the healthcare system as demands for medical checkups increase. Chinese people have reported increasing discrimination. The health minister has pointed out that the situation has not reached a point where mass gatherings must be called off.

Aviation, retail and tourism sectors have reported decreased sales and some manufactures have complained about disruption to Chinese factories, logistics and supply chains. Prime Minister Abe has considered using emergency funds to mitigate the outbreak's impact on tourism, of which Chinese nationals account for 40%. S&P Global noted that the worst hit shares were from companies spanning travel, cosmetics and retail sectors which are most exposed to Chinese tourism. Nintendo announced that they would delay shipment of the Nintendo Switch, which is manufactured in China, to Japan.

The outbreak itself has been a concern for the 2020 Summer Olympics which is scheduled to take place in Tokyo starting at the end of July. The national government has thus been taking extra precautions to help minimise the outbreak's impact. The Tokyo organising committee and the International Olympic Committee have been monitoring the outbreak's impact in Japan.

### Hong Kong

Hong Kong has seen high-profile protests that saw tourist arrivals from Mainland China plummet over an eight-month period. The viral epidemic put additional pressure on the travel sector to withstand a prolonged period of downturn. A drop in arrivals from third countries more resilient during the previous months has also been cited as a concern. The city is already in recession and Moody has lowered the city's credit rating. The worst economic effects from the outbreak are expected for Australia, Hong Kong and China.

There has also been a renewed increase in protest activity as hostile sentiment against Mainland Chinese strengthened over fears of viral transmission from Mainland China, with many calling for the border ports to be closed and for all Mainland Chinese travellers to be refused entry. Incidents have included a number of petrol bombs being thrown at police stations, a homemade bomb exploding in a toilet, and foreign objects being thrown onto transit rail tracks between Hong Kong and the Mainland Chinese border. Political issues raised have included concerns that Mainland Chinese may prefer to travel to Hong Kong to seek free medical help (which has since been addressed by the Hong Kong government).

Since the outbreak of the virus, a significant number of products have been sold out across the city, including face masks and disinfectant products (such as alcohol and bleach). An ongoing period of panic buying has also caused many stores to be cleared of non-medical products such as bottled water, vegetables and rice. The Government of Hong Kong had its imports of face masks cancelled as global face mask stockpiles decline.

In view of the coronavirus outbreak, the Education Bureau closed all kindergartens, primary schools, secondary schools and special schools until 17 February. This was later extended to 1 March due to further development of the epidemic. The disruption has raised concerns over the situation of students who are due to take examinations at the end of the year, especially in light of the protest-related disruption that happened in 2019.

On 5 February, flag carrier Cathay Pacific requested its 27,000 employees to voluntarily take three weeks of unpaid leave by the end of June. The airline had previously reduced flights to mainland China by 90% and to overall flights by 30%.

### Macau

On 4 February 2020, all casinos in Macau were ordered to shut down for 15 days.

### Southeast Asia

Among Association of Southeast Asian Nations countries, the city-state of Singapore was forecast to be one of the worst hit countries by Maybank. The tourism sector was considered to be an "immediate concern" along with the effects on production lines due to disruption to factories and logistics in mainland China. Singapore has witnessed panic buying of essential groceries, and of masks, thermometers and sanitation products despite being advised against doing so by the government. Prime Minister Lee Hsien Loong said that a recession in the country is a possibility, and that the country's economy "would definitely take a hit".

Maybank economists rated Thailand as being most at risk, with the threat of the viral outbreak's impact on tourism causing the Thai baht to fall to a seven-month low.

In Malaysia, economists predicted that the outbreak would affect the country's GDP, trade and investment flows, commodity prices and tourist arrivals. Initially, the cycling race event Le Tour de Langkawi was rumoured to be cancelled, but the organiser stated that it would continue to be held as usual. Despite this, two cycling teams, the Hengxiang Cycling Team and the Giant Cycling Team, both from China, were pulled from participating in this race due to fear of the coronavirus outbreak. As the outbreak situation has worsened, some of the upcoming concerts held in Kuala Lumpur, such as Kenny G, Jay Chou, The Wynners, Super Junior, Rockaway Festival and Miriam Yeung, were postponed to a future date, and the upcoming Seventeen concert was cancelled.

In Indonesia, over 10,000 Chinese tourists were restricted trips and flights to major destinations such as Bali, Jakarta, Bandung, etc. are cancelled over coronavirus fears. Many of existing Chinese visitors are queuing up with the Indonesian authority appealing for extended stay.

Prime Minister Hun Sen of Cambodia made a special visit to China with an aim to showcase Cambodia's support to China in fighting the outbreak of the epidemic.

### South Asia

In India, economists expect the near-term impact of the outbreak to be limited to the supply chains of major conglomerates, especially pharmaceuticals, fertilisers, automobiles, textiles and electronics. A severe impact on global trade logistics is also expected due to disruption of logistics in Mainland China, but due to the combined risk with regional geopolitical tensions, wider trade wars and Brexit.

In Sri Lanka, research houses expect the economic impact to be limited to a short term impact on the tourism and transport sectors.

### Taiwan

On 24 January, the Taiwanese government announced a temporary ban on the export of face masks for a month to supply masks for its citizens. On 2 February 2020, Taiwan's Central Epidemic Command Center postponed the opening of primary and secondary schools until 25 February. Taiwan has also announced a ban of cruise ships from entering all Taiwanese ports. In January, Italy has banned flights from Mainland China, Hong Kong, Macau and Taiwan. On 10 February, the Philippines announced to ban the entry of Taiwanese citizens because of the One-China Policy. Later on 14 February, Presidential Spokesperson of Philippines, Salvador Panelo, announced to lift the temporary ban on Taiwan.

In the aviation industry, Taiwanese carrier China Airlines's direct flights to Rome have been rejected and cancelled since Italy has announced the ban on Taiwanese flights. On the other hand, the second-largest Taiwanese carrier, Eva Air, has also postponed the launch of Milan and Phuket flights. Both Taiwanese airlines have cut numerous cross-strait destinations, leaving just three Chinese cities still served. Filipino carriers such as Philippines Airlines, Cebu Pacific, and Philippines AirAsia have suspended flights to Taiwan because of the entry ban from the Philippines.

### United States

The viral outbreak was cited by many companies in their briefings to shareholders, but several maintained confidence that they would not be too adversely affected by short-term disruption due to "limited" exposure to the Chinese consumer market. Those with manufacturing lines in mainland China warned about possible exposure to supply shortages.

Silicon Valley representatives expressed worries about serious disruption to production lines, as much of the technology sector relies on factories in Mainland China. Since there had been a scheduled holiday over Lunar New Year, the full effects of the outbreak on the tech sector were considered to be unknown as of 31 January 2020[update], according to *The Wall Street Journal*.

Cities with high populations of Chinese residents have seen an increase in demand for face masks to protect against the virus; many are purchasing masks to mail to relatives in Mainland China, Hong Kong, and Macau, where there is a shortage of masks.

As of February 2020[update], many stores in the United States had sold out of masks. This mask shortage has caused an increase in prices.

Universities in the United States have warned about a significant impact to their financial income due to the large number of Chinese international students potentially unable to attend classes.

## Environmental impacts

The outbreak can lead to a decrease in greenhouse gas emission because of its effect on the economy.