Timeline Page

2019

November

A confirmed case of the novel coronavirus emerged on 17 November 2019, according to 13 March 2020 reports of official Chinese government sources, but was not recognized at that time. There may have been earlier patients; the search for them continues.

December 27 Cases

The first known patient started experiencing symptoms on 1 December 2019. He had not been to the Huanan Seafood Wholesale Market of Wuhan. No epidemiological link could be found between this case and later cases.

Between 8 and 18 December 2019, seven cases later diagnosed as COVID19 were documented; two of them were linked with the Huanan Seafood Wholesale Market; five were not.

Chinese state broadcaster CCTV reported in a broadcast airing on 12 January 2020 that a "new viral outbreak was first detected in the city of Wuhan, China, on 12 December 2019".

Studies are performed to further identify the virus.

According to a post at China Youth Daily, Wuhan Fifth Hospital gastroenterology director Lu Xiaohong reported suspected infection by hospital staff on 25 December.

A cluster of patients late December is linked to the Wuhan Food Market. At that stage, there are already several Previous patients without any known connection to that market, but in he subsequent months, the Wuhan Market Cluster will fuel theories of this being the ‘ground zero’ of the epidemic.

Other clusters appear, also in Chinese health care facilities. A whistleblower ophthalmologist is disciplined in public, and forced to work with COVID19 patients. He is subsequently infected and dies of the complications.

By the end of December 2019, 27 suspected cases in total, seven of which were in critical condition and 18 were stable, two of which were on the verge of being discharged soon. The Wuhan Municipal Health Committee reported to the WHO that 27 people had been diagnosed with pneumonia of unknown cause. Early investigations into the cause of the pneumonia ruled out seasonal influenza, SARS, Middle East respiratory syndrome and bird flu.

HongKong decides that "any suspected cases including the presentation of fever and acute respiratory illness or pneumonia, and travel history to Wuhan within 14 days before onset of symptoms, we will put the patients in isolation." WHO reports this outbreak on 31 December 2019 and monitors the follow up closely.

2020

January 9,826 cases

This month, the number of cases will increase from 44 to 9,826 and will spread from China to 15 other countries, including France, Germany, Italy and UK.

Like HongKong, Taiwan and Singapore also implement health precautions in the first week of January: arrivals on direct flights from Wuhan are being screened for flu-like symptoms on the tarmac in Taipei before they can disembark. China is clearly sensoring public reports of the disease, and publicly reprimands whistleblowers.

WHO (first) and ECDC (4 days later) publish risk assessments of the situation. . Remarkable is that ECDC states "Considering there is no indication of human-to-human transmission and no cases detected outside of China, the likelihood of introduction to the EU is considered to be low, but cannot be excluded.", despite knowing that previous severe coronavirus infections (SARS, MERS) emerging in humans have all transmitted from person to person.

WHO issues its first guidance on the novel coronavirus to help countries check their ability to detect and respond to a novel coronavirus, identifying main gaps, assessing risks and planning for additional investigations, response and control actions. China starts sharing the genetic code of the virus. ECDC updates countries (on 18 January) and mentions the interconnection with China (300 000 Passengers/month EU <--> China); they advise to identify possible cases among returning travelers. WHO manages to get a large (200+) joint mission to China, to assess the situation. Such external assessment in China is unprecedented and facilitated sharing of knowledge and tools.

ECDC states on 21 January that there is a moderate likelihood of detecting cases imported into EU/EEA countries, yet that “the likelihood of a case reported in the EU resulting in secondary cases within the EU/EEA is low”. Four days later, ECDC reports that the outbreak evolves rapidly and that person to person spread is likely. WHO struggles in calling this a Public Health Emergency of International Concern (PHEIC), because of the international legal consequences.

On 26 January, ECDC follows its first Risk Assessment with the advice that “the impact of the late detection of an imported case in an EU/EEA country without the application of appropriate infection prevention and control measures would be high, therefore in such a scenario the risk of secondary transmission in the community setting is estimated to be very high”. This urges all countries to focus fully on containment. Four days later, WHO calls it a PHEIC, while all 5 regions have now been affected.

February 85,203 cases

This month, the pandemic (even when WHO refuses to categorize it as such) will grow from 9826 to 85,203 cases (growth factor 8.5).

Early February, there are 16 cases in 5 EU countries with local transmission. China takes unprecedented control measures. ECDC still advises that risk of person to person transmission in EU countries is low, provided that all imported cases are detected promptly, isolated and all their contacts traced and quarantined. In 24 EU countries, 38 labs had COVID19 tests available, yet availability of primers/probes, positive controls and personnel were main implementation barriers.

ECDC publishes “Guidelines for the use of non-pharmaceutical measures to delay and mitigate the impact of 2019-nCoV”. This includes surgical masks for care providers of suspect COVID19 cases and those with extensive public contact. Few countries at that moment adapt the advice to provide masks to professionals with extensive public contact, though that will change in May and June. In addition, ECDC states that “school children are considered to be one of the main drivers of respiratory virus spread in the community”, though it is not yet known how much nCoV2 transmission will occur among children. “Proactive school closures may be considered if there is ongoing transmission of 2019-nCoV in an area”. Countries like the Netherlands contradict this advice by stating that children do not contribute significantly to COVID19 transmission (though no evidence at that time would support such policy advice).

Meanwhile, WHO steps up the warnings to other countries, as it views the complacency of many as a threat to effective pandemic control. On 11 February, Director General Dr. Tedros says that every country should take this virus very seriously. He is losing sleep over it, and he expects that every government should lose sleep over it. This virus should be seen as 'public health enemy nr 1'. "There is a window of opportunity. If we lose it, we will regret it. You need to hit hard, fast". At that moment, carnaval celebrations are about to start in many countries including the Netherlands, and in March it will be discovered that allowing carnaval was a major factor in accelerating the exponential spread.

The UN activates WHO-led Crisis Management Team (with executive director dr Mike Ryan), bringing together WHO, OCHA, IMO, UNICEF, ICAO, WFP, FAO, the World Bank and several UN Secretariat departments.

ECDC publishes further guidance and advises to recognize the community as a partner, and to develop an understanding of community perceptions, promote community debriefing, dialogue and a culture of shared learning. Also, ECDC urges countries to roll-out primary testing capacity to local clinical and diagnostic laboratories. For some countries, such as the Netherlands, restricted testing capacity will be a major obstacle in addressing the pandemic effectively, at least until June. Other countries, including Germany, Iceland, find ways to rapidly roll out diagnostic capacity.

ECDC underlines that during the containment phase, extensive tracing and risk assessment of contacts of probable and confirmed cases detected in EU/EEA countries is required in order to minimize the further spread and to strengthen the evidence base on the characteristics and transmission pattern of the disease. Suspected, probable or confirmed cases of COVID19 should be reported to the public health authorities and managed in accordance with national guidance and/or WHO’s patient management guidelines. In several countries, the pandemic is politicized and China (and Chinese people) are blamed. WHO strongly responds: "We must be guided by solidarity, not stigma. The greatest enemy we face is not the virus itself; it’s the stigma that turns us against each other. We must stop stigma and hate.“ (Dr. Tedros)

In the second half of February, WHO warns that the ‘window of opportunity is narrowing’. WHO publishes guidance on getting workplaces ready for COVID19. By the end of the month, EU has 770 cases, including 18 deaths in 19 countries.

March 777,798 cases

This month, the global case-counter will advance from 87,024 to 777,798 cases; a growth factor of 8.9.

ECDC publishes new guidance and risk assessments. It emphasizes the importance to enhance surveillance, epidemiological investigation, close contact tracing, management of close contacts, immediate case detection and isolation. “There’s no choice but to act now” (WHO, Dr Tedros) A shortage of personal protective equipment endangering health workers worldwide

The WHO R&D roadmap for COVID-19 outlines research priorities in 9 key areas. These include the natural history of the virus, epidemiology, diagnostics, clinical management, ethical considerations and social sciences, as well as longer-term goals for therapeutics and vaccines.

WHO: “All countries must aim to stop transmission and prevent the spread of COVID-19, whether they face no cases, sporadic cases, clusters or community transmission.“ and (finally) calls the COVID19 PHEIC a pandemic on 11 March.

Europe becomes the epicenter of the pandemic

WHO keeps insisting that countries should test every suspected case of COVID-19. Meanwhile, countries that have failed to ramp up diagnostic capacity, are forced to prioritize testing. In the Netherlands, this leads on 12 March to the decision to let go of the containment strategy, and to move to mitigation efforts. As a consequence, NL suspends the national obligatory notification of suspect covid cases: the epidemic progresses exponentially as the country struggles to double ICU capacity, while practically suspending all non-essential medical procedures.

COVID19 starts to affect areas in the world that are already plagued by severe humanitarian crises. The UN Secretary-General calls for solidarity, hope and political will.

WHO and FIFA team up on a campaign to kick out coronavirus

ECDC Risk Assessment: The risk of severe disease associated with COVID-19 for people in the EU/EEA and the UK is currently considered moderate for the general population and very high for older adults and individuals with chronic underlying conditions. The risk of occurrence of widespread national community transmission of COVID-19 in the EU/EEA and the UK in the coming weeks is moderate if effective mitigation measures are in place and very high if insufficient mitigation measures are in place.

Several parties in the lower house of Dutch parliament are in favor of forcing pharmaceutical company Roche to release the manufacturing process and recipe of the coronavirus test they make if this is necessary. This would make it possible for tests to be produced in the Netherlands, NOS reports. Some time later, the Switzerland based pharmaceutical company Roche releases the detailed guidelines on how to prepare the lysis buffer fluid for the COVID19 test, after pressure and negotiations with Dutch ministry of health. UK Prime Minister Boris Johnson tests positive for SARS-CoV2.

April

1 April (853,200 cases)

• ECDC Publishes "An overview of the rapid test situation for COVID-19 diagnosis in the EU/EEA"

2 April (928,437 cases)

• WHO begins the #HealthyAtHome campaign:
  • #HealthyAtHome campaign website
  • Challenge launch video

3 April (1,000,249 cases)

• Total deaths since 31 December 2019 are 51,515 globally.

4 April (1,082,054 cases)

• UK Prime Minister Boris Johnson is hospitalised with #COVID19

6 April (1,244,421 cases)

• WHO Situation Report 77:

8 April (1,391,888 Cases)

• ECDC Publishes:
  • a new Rapid Risk Assessment (RRA #8)
  • Guidance for discharge and ending isolation in the context of widespread community transmission of COVID-19 – first update.
  • Using face masks in the community - Reducing COVID-19 transmission from potentially asymptomatic or pre-symptomatic people through the use of face masks.

9 April (1,476,818 Cases)

• ECDC Publishes:
  • Strategies for Surveillance of COVID19.
  • Contact tracing: Public health management of persons, including healthcare workers, having had contact with COVID-19 cases in the European Union - second update.

14 april (1,873,265 Cases)

ECDC posts infographic: using face masks in the community:

15 april (1,948,511 cases)

• The German Federal Ministry has agreed with the German States the following:
  • Guiding principle: "to protect all people in Germany as well as possible from the infection"
  • The most important measure for the coming time remains to keep your distance.
  • In order to quickly identify infection chains in the future, carry out targeted tests, ensure full contact tracking and provide professional care for those affected, considerable additional personnel capacities are created in the local public health services, at least one team of 5 people per 20,000 inhabitants
  • The use of digital “contact tracing” is a key measure to support the quick and complete tracking of contacts. The federal government and the federal states support the architectural concept of "Pan-European Privacy-Preserving Proximity Tracing" because it follows a pan-European approach, provides for compliance with European and German data protection rules and only anonymizes epidemiologically relevant contacts of the last three weeks on the user's mobile phone without saves the recording of the movement profile. In addition, the use of the app should be voluntary
  • Germany has a high test capacity of up to 650,000 tests a week to detect corona infections (PCR tests). The federal government secures additional test capacities for Germany by purchasing test equipment
  • Large events play a major role in infection dynamics, which is why they remain prohibited at least until August 31, 2020
  • The following shops can also reopen under conditions of hygiene, to control access and to avoid queues:
    • all shops up to 800 sqm sales area
    • and regardless of the sales area car dealers, bicycle dealers, bookstores.

17 April (2,114,269 cases)

• The Dutch National Guidelines for COVID19 Control are updated
  • Testing policy is still restricted to only high-risk groups and health care workers
  • source and contact tracing are said not to be a priority
  • Contact tracing is restricted to contacts that could transmit COVID to high-risk groups

• Dr Tedros mentions the solidarity response and calls for a joint response from private and public sectors. Here is the video of the WHO briefing:

18 April (2,197,593 cases)

• One World: Together At Home concert

20 April (2,355,853 cases)

• ECDC Published Infographic CONTACT TRACING:

23 April (2,579,823 cases)

• ECDC publishes the 9th Rapid Risk Assessment: Coronavirus disease 2019 (COVID-19) in the EU/EEA and the UK– ninth update
  • It includes public health objectives: "Limit and control virus circulation and transmission in the general population now (flattening the curve) and for the years to come to maintain the number of new SARS-CoV-2 infections at manageable levels for the healthcare system, and possibly allowing for gradual acquisition of population immunity."; this suggests that ECDC has given up the ambition of containment, and joins the member states that aim for group immunity, and 'controlled circulation'

24 April (2,657,910 cases)

• WHO's Regional Office for Europe has published key considerations for the gradual easing of the lockdown restrictions introduced by many countries in response to the spread of COVID-19 across the European Region.
  • The transition out of lockdown is set to be a complex and uncertain phase. Challenges and circumstances vary from country to country and there is no one-size-fits-all approach. It is vital that countries clearly communicate this to the public to build trust and ensure that people observe restrictions specific to their situation.

28 April (2,981,427 cases)

• The Global Outbreak Alert and Response Network (GOARN) marks its 20th anniversary
• The WHO Director-General, Executive Director of the Health Emergencies Programme and COVID-19 Technical Lead addressed the Inter-Parliamentary Union's webinar on reducing risks, strengthening emergency preparedness and increasing resilience.

29 April (3,054,404 cases)

• ECDC publishes "Considerations for infection prevention and control measures on public transport in the context of COVID-19"
• ECDC Updates the Technical Report "Coronavirus disease 2019 (COVID-19) and supply of substances of human origin in the EU/EEA - First update"

30 April (3,130,790 cases)

• The WHO-IHR Emergency Committee met and issued its statement.
  • Membership of the Emergency Committee was expanded to reflect the nature of the pandemic and the need to include additional areas of expertise.
  • The Committee unanimously agreed that the outbreak still constitutes a public health emergency of international concern (PHEIC) and offered advice to the Director-General, who declared that the outbreak of COVID-19 continues to constitute a PHEIC.
  • The Committee issued advice to WHO on: coordination, planning, and monitoring; One Health; essential health services; risk communication and community engagement; surveillance and travel and trade.
  • The Committee also issued advice to all States Parties on: coordination and collaboration; preparedness; surveillance; additional health measures; health workers; food security; One Health; risk communication and community engagement; research and development; and essential health services

1 May (3,214,256 cases)

• WHO and the European Investment Bank (EIB) will boost cooperation to strengthen public health, the supply of essential equipment, training, and investment in countries most vulnerable to the COVID-19 pandemic. The first phase will address urgent needs and strengthen primary health care in ten African countries. The agreement establishes a close collaboration to overcome market failure and stimulate investments in global health, accelerating progress towards Universal Health Coverage.

5 May (3,545,486 cases)

• ECDC publishes: Contact tracing for COVID-19: current evidence, options for scale-up and an assessment of resources needed.

10 May (3,986,931 cases)

• WHO publishes contact tracing guidelines.
  • Critical elements of the implementation of contact tracing are community engagement and public support; careful planning and consideration of local contexts, communities, and cultures; a workforce of trained contact tracers and supervisors; logistics support to contact tracing teams; and a system to collate, compile, and analyse data in real-time
  • Because individuals may transmit COVID-19 while pre-symptomatic or asymptomatic, this guidance also emphasizes the importance of quarantining contacts to further reduce the potential for secondary transmission.
  • Contact tracing may be difficult when the transmission is intense (community transmission) but should be carried out as much as possible.
  • When countries have passed the peak of transmission and case numbers are decreasing, and particularly when stringent public health and social measures are being adjusted, rapid identification of cases and contact tracing are critical to maintain low levels of transmission and rapidly identify and break new transmission chains.

13 May (4,223,701 cases)

• ECDC Publishes a 3rd update of the Technical Report "Infection prevention and control and preparedness for COVID-19 in healthcare settings - third update"

15 May (4,406,317 cases)

• ECDC published a Rapid Risk Assessment: Paediatric inflammatory multisystem syndrome and SARS-CoV-2 infection in children.
  • Rare disease: symptoms are a mix of the ones for Kawasaki disease (KD) and toxic shock syndrome (TSS) and are characterised, among others, by fever, abdominal pain and cardiac involvement.
  • In total, about 230 suspected cases of this new paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) have been reported in EU/EEA countries and the UK in 2020, including two fatalities, one in the UK and one in France. Investigation is ongoing.

19 May (4,766,900 cases)

• ECDC publishes "Surveillance of COVID-19 at long-term care facilities in the EU/EEA"
  • and the “Infographic: COVID-19 in care homes“

20 May (4,861,975 cases)

• ECDC publishes technical report “COVID-19 Aviation Health Safety Protocol: Guidance for the management of airline passengers in relation to the COVID-19 pandemic”

26 May (5,460,254 cases)

• ECDC publishes:
  • technical report “Considerations for travel-related measures to reduce spread of COVID-19 in the EU/EEA”
  • technical report “Projected baselines of COVID-19 in the EU/EEA and the UK for assessing the impact of de-escalation of measures”

29 May (5,777,512 cases)

• ECDC publishes poster “Poster: COVID-19 - Plan your journey” on what to do when you will fly on an airplane.

4 June (6,475,978 cases)

• ECDC publishes technicap report “Conducting in-action and after-action reviews of the public health response to COVID-19”

8 June (6,960,259 cases)

• ECDC publishes technical report on “Options for the decontamination and reuse of respirators in the context of the COVID-19 pandemic”