Updated on April 7, 2020, at 10.45 am
Globally, by April 06, 2020 (10.00 pm CET), according to the WHO*, 1,210,956 cases of Covid-19 have been confirmed and 67,594 patients have died. In addition to confirmed cases, there are also suspected cases of Covid-19, the definition of which is evolving as times passes and the epidemic propagates. Furthermore the criteria vary from one country to another.
In France, on April 06, 2020 (2.00 pm CET), according to the French national public health agency Santé publique France**, 74,390 cases of Covid-19 have been confirmed, 54,036 people are still hospitalized, of whom 7,072 are currently in intensive care, and 8,911 patients died. The others are diagnosed and cared for in hospitals, or cured and discharged from hospital. Again according the Santé publique France, there are two different types of cases: possible cases and confirmed cases. The first type concerns people who present clinical signs according to the different possibilities of exposure established by the health authorities (for example, a recent trip to China, direct contact or proximity to a confirmed case, itinerary similar to that of a confirmed case, etc.). The second type, confirmed cases, are possible cases for which the analysis of a sample has confirmed infection by SARS-CoV-2.
Some key dates
After an epidemic outbreak in China in January and February, during the weekend of February 22-23, 2020, the epidemic situation evolved worldwide with the intensification of outbreaks in South Korea, Japan, and Singapore, and the appearance of new outbreaks in Iran and Italy. In these countries, we are witnessing a community transmission with no identified link with cases imported from China.
By the end of February, 2020, two months after its appearance in China, the epidemic seemed to have peaked there. On March 9, 2020, the Chinese authorities announced the reopening of some public places and the closure of field hospitals, while the number of new cases is sharply decreasing in the country.
On March 10, 2020, all countries of the European Union are now affected by Covid-19.
On March 11, 2020, the WHO announced that Covid-19 could be described as a pandemic, the first triggered by a coronavirus.
On March 14, 2020, France entered the "stage 3" of an active epidemic on its territory. To slow down dissemination on the territory and reduce the risk of tension on the hospital system for taking care of the most serious cases, social distancing measures are reinforced, with the closure of all places of non-essential groupings (cafes, restaurants, cinemas, discos...). Food stores, pharmacies, banks, tobacconists (newspaper sale points), petrol stations… remain open (with full stalls).
On March 16, 2020, the president of France decided to put in place measures to reduce social contact and restrict movement as much as possible. On March 17 at 12 noon, a containment system was put in place for the entire French territory for a minimum of 15 days. Movement was banned except in certain cases: see Gouvernement.fr.
On March 16, the WHO counted almost as many cases inside China as outside of China: 165,515 cases were confirmed worldwide with 81,077 in China and 86,438 outside of China (in 143 different countries). 3,218 deaths were counted inside China and 3,388 outside of China.
This pneumonia is an infectious disease caused by a virus belonging to the coronavirus family, currently referred to as SARS-CoV-2. The reservoir of the virus is probably of animal origin, even if SARS-CoV-2 is very close to a virus detected in a bat, the animal at the origin of the transmission to humans has not yet been definitely identified.
- The duration of incubation is an average of 5 days, with extremes of 2 to 12 days. The onset of symptoms appears gradually over several days, unlike the flu which starts suddenly.
- The first symptoms are not very specific: headache, muscle pain, fatigue/tiredness. Fever and respiratory signs occur secondarily, often two or three days after the first symptoms.
- In the first descriptive studies from China, an average of one week elapsed between the onset of the first symptoms and admission to the hospital in the disease phase. At this stage, the symptoms combine fever, cough, chest pains and respiratory discomfort. The performance of a chest scanner almost always shows pneumonia affecting both lungs. Other clinical signs have been described since the first studies: signs of involvement of the central nervous system, expressed in particular in elderly people in the form of disorientation; sudden loss of taste and/or smell, an event that remains infrequent but confirms the diagnosis of Covid-19.
- The severity of clinical signs requires that approximately 20% of patients remain in hospital and 5% require admission to intensive care. The most serious forms are observed mainly in people who are vulnerable because of their age (over 70) or associated diseases.
- Specific observational studies (such as the one carried out on passengers on the Diamond Princess cruise ship) as well as modeling work have shown that the infection can be asymptomatic or paucisymptomatic (causing little or no clinical manifestations) in 30 to 60% of infected subjects.
Most of the initially described cases concerned people who had been to a market selling live animals. The leading hypothesis is therefore that the virus is a zoonosis (a disease transmitted by animals). Human-to-human transmission is established and it is estimated that, in the absence of control and prevention measures, each patient infects between 2 and 3 people.
How is it diagnosed?
A diagnostic test for the Covid-19 coronavirus is carried out in all referral health establishments, in the case of suspicion of the disease by the SAMU (French emergency medical service) and by a referent infectiologist. This test concerns any person with signs of acute respiratory distress syndrome for which no etiology could be identified, without any notion of travel / stay in a risk exposure area or close contact with a confirmed case of Covid-19. In addition, the definition of close contact now includes all contact from 24 hours before the onset of symptoms in a confirmed case of Covid-19.
These definitions in France can change at any time, depending on the information available, and can be read on the Santé publique France website (page in French).
A specific diagnostic test, developed by the National Reference Center for Respiratory Viruses (Including Influenza) at the Institut Pasteur to detect the new virus via respiratory samples, is available in many hospitals across France.
There is currently no specific treatment – with demonstrated efficacy – against Covid-19. There is currently no specific treatment – with demonstrated efficacy – against Covid-19. Different medicines are in the process of being evaluated by way of clinical studies in which doctors are invited to ask patients with Covid-19 to participate. The French High Council for Public Health (Haut Conseil de la Santé Publique) issued an opinion on March 23, 2020 on the therapeutic recommendations for the management of Covid-19 (site in French.)
Instructions in France : “I have symptoms (cough, fever) that remind me of Covid-19: I stay at home, I avoid contact with others, and I can do a self-evaluation as to the severity of my state on line at maladiecoronavirus.fr (site in French.) I can also benefit from a medical video consultation. I do not go to the doctor’s office without having phoned beforehand.
If the symptoms worsen with breathing difficulties and signs of suffocation, I call the “SAMU-Center 15”; experts will decide what to do. (source in French Gouvernement.fr)”
Avoid contact with those around you. Do not go to your doctor or to the emergency room, to avoid any potential contamination. Limit travel to what is strictly necessary.
Some frequently asked questions (updated on February 25, 2020)
- What is the animal reservoir?
A virus, 96% identical to SARS-CoV-2, has been identified in bats captured in China. The bat is therefore most likely the reservoir of the virus.
- How is the virus transmitted from animals to humans?
It is likely that a mammal served as an intermediate host between the bat and man. This intermediate animal is not identified with certainty, but the pangolin is suspected.
- Can the virus survive in the environment? And if so, for how long?
According to the available data, the survival of coronaviruses in the outdoor environment is only a few hours on dry inert surfaces. Given duration and conditions of transport between France and China, the risk of becoming infected with SARS-CoV-2 by touching an object imported from China is considered extremely low. Standard hygiene measures (hand washing, surface cleaning) are effective.
- How long is the incubation?
The duration of incubation is an average of 5 to 6 days, with extremes of 2 to 12 days, which justifies the quarantine period of 14 days.
- How is Covid-19 diagnosed in patients?
The diagnosis is suspected in front of signs of respiratory infection in a person returning from a place where the virus circulates, in the 14 days preceding the symptoms onset, according to the case definition of Santé publique France.
- What is the period of contagiousness?
Contagiousness seems to start with the appearance of symptoms, even a few days before for some people. This period of contagiousness would last longer in symptomatic people, especially when they cough.
International research efforts are continuing, including at the Institut Pasteur in Paris and in the Institut Pasteur International Network, to clarify the answers to these questions.
At the Institut Pasteur
In line with its mission to monitor influenza and respiratory viruses in France, the Institut Pasteur has mobilized its teams at the French National Research Center for Respiratory Viruses (Including Influenza) [page in French] and the Laboratory for Urgent Response to Biological Threats (CIBU) [page in French] to identify and confirm suspected cases of acute respiratory infection linked to the new coronavirus (SARS-CoV-2).
On Friday, January 24, 2020, the National Reference Center for Respiratory Infections Virus (including influenza) confirmed the first three cases of patients affected by the SARS-CoV-2 coronavirus on French territory. From these samples, the researchers were able to start sequencing the viral genome and have the complete sequence by Wednesday, January 29, allowing it to be compared with the twenty or so other sequences present in the world.
At the same time, the National Reference Center continued its work on samples in order to rapidly isolate the virus and make it available to researchers. Cell culture is a crucial step to allow further research work.
A Task Force has been set up at the Institut Pasteur (Paris) to respond to the urgency of this health crisis. This Task Force mobilizes the experts of the Institut Pasteur on various scientific areas:
- Understanding more about the virus and its pathogenesis;
- Developing new diagnostic tools and searching for antibodies that may have therapeutic applications;
- Vaccine development;
- Epidemiology and modeling to develop outbreak control strategies.
All Covid-19 news from the Institut Pasteur
Video Covid-19 : What we have learnt as of 20 February 2020 by Arnaud Fontanet
The content of this video is dated. The information it contains is subject to change and modification as the epidemic progresses.
* To follow the latest news on the novel coronavirus, visit the World Health Organization website.
** To follow the evolution of current events in France, visit the website of the French Ministry in charge of health.
*** For the procedure to be followed in France, visit the Santé publique France website.
Set up on Saturday February 1st, a French freephone number for information on the coronavirus (0800 130 000)