COVID-19 infections just hit 20 million worldwide — why the actual number of cases is likely much higher

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The world is still in the grip of the first wave of the coronavirus pandemic.

COVID-19 hit another unwelcome milestone on Tuesday morning as the number of COVID-19 infections hit 20,092,855 globally, according to the latest data aggregated by Johns Hopkins University’s Center for Systems Science and Engineering. The virus has infected least 5,094,565 people in the U.S., the most of any country, followed by Brazil (3,057,470), India (2,268,675) and Russia (890,799).

However, the actual number of cases in both the U.S. and worldwide is likely much higher, health authorities say. The Centers for Disease Control and Prevention estimates that 40% of people with COVID-19 are actually asymptomatic. Other data suggested that 16% of coronavirus transmission is due to carriers not displaying symptoms of the illness, or only show very mild symptoms and, while they’re contagious, may not believe they have the disease.

The World Health Organization estimates that 16% of people with COVID-19 are asymptomatic, while other data show that 40% of coronavirus transmission is due to carriers not displaying symptoms of the illness.

“A recent study from China that clearly and appropriately defined asymptomatic infections suggests that the proportion of infected people who never developed symptoms was 23%,” the World Health Organization said last month. “Multiple studies have shown that people infect others before they themselves became ill, which is supported by available viral shedding data. One study of transmission in Singapore reported that 6.4% of secondary cases resulted from pre-symptomatic transmission.”

COVID-19 has now killed at least 736,254 people worldwide. The U.S. has the highest number of deaths of any country (163,465), followed by Brazil (101,752), Mexico (53,003), the U.K. (46,611) and India (45,257). With 10,474 deaths, California recently became the third U.S. state to register over 10,000 deaths after New York (32,781 deaths) and New Jersey (15,878 deaths). The U.S. also ranks 15th in the world for deaths per 100,000 people (49.5), Johns Hopkins University said.

“Transmission of SARS-CoV-2 can occur through direct, indirect, or close contact with infected people through infected secretions such as saliva and respiratory secretions or their respiratory droplets, which are expelled when an infected person coughs, sneezes, talks or sings,” WHO said. This makes asymptomatic transmission all the more prevalent, scientists say.

However, all studies on asymptomatic people have limitations, WHO added. “For example, some studies did not clearly describe how they followed up with persons who were asymptomatic at the time of testing to ascertain if they ever developed symptoms. Others defined ‘asymptomatic’ very narrowly as persons who never developed fever or respiratory symptoms, rather than as those who did not develop any symptoms at all.”

America’s COVID-19 death toll in the U.S. could reach nearly 300,000 by Dec. 1, but consistent mask-wearing beginning today could save approximately 70,000 lives, according to the Institute for Health Metrics and Evaluation (HME) at the University of Washington’s School of Medicine. “It appears that people are wearing masks and socially distancing more frequently as infections increase, then after a while as infections drop, people let their guard down and stop taking these measures to protect themselves and others,” HME director Christopher Murray said.

Dispatches from a pandemic:‘It should have been mandatory from the beginning’: Ireland says people must wear masks in stores to stop COVID-19 — but why did it take so long?

Last month, California Gov. Gavin Newsom announced a rollback of operations state-wide at restaurants as well as bars, zoos, wineries, museums, card rooms, and movie theatres. “This is in every county in the state of California, not just those on the watch list,” he said. In addition, the shutdown also affects indoor operations of gyms, places of worship, offices for non-critical offices, hairdressers, beauty salons, indoor malls, and other places of businesses in 30 counties on California’s ”monitoring list,” and represent 80% in the state of California.

On the anniversary of the 1918 flu, health writer Ed Yong warned of another pandemic and now says the U.S. must learn the lessons from the past seven months, adding, “COVID-19 is merely a harbinger of worse plagues to come.”

“Despite ample warning, the U.S. squandered every possible opportunity to control the coronavirus. And despite its considerable advantages — immense resources, biomedical might, scientific expertise — it floundered,” he wrote in the September issue of The Atlantic. While South Korea, Thailand, Iceland, Slovakia, and Australia acted “decisively” to flatten and then bend the curve of new infections downward, “the U.S. achieved merely a plateau in the spring, which changed to an appalling upward slope in the summer,” he said.

Yong said he has spoken to over 100 health experts since the pandemic began and sums up the U.S. mistakes thus: “A sluggish response by a government denuded of expertise allowed the coronavirus to gain a foothold,” compounded by “chronic underfunding of public health,” he said. “A bloated, inefficient health-care system left hospitals ill-prepared for the ensuing wave of sickness. Racist policies that have endured since the days of colonization and slavery left Indigenous and Black Americans especially vulnerable to COVID‑19,” Yong added.

Dispatches from a pandemic: A letter from Chennai as India tops 2 million COVID-19 cases: ‘In the midst of so much death, despair and depression, life does go on’

In New York City, the epicenter of the pandemic in the U.S., was a case study in how some Americans fared better than others. Black and Latino people were hospitalized at twice the rate of Caucasians during the peak of the crisis, data released in May by the City of New York showed. Black New Yorkers were hospitalized at a rate of 632 per 100,000 people, while Caucasians were hospitalized at a rate of 284 per 100,000 people. Black and Hispanic residents were dying at a rate of 21.3 per 100,000, while non-white races were dying at a rate of 40.2 per 100,000, it added.

President Donald Trump on Saturday bypassed the nation’s lawmakers as he claimed the authority to defer payroll taxes and replace an expired unemployment benefit with a lower amount after negotiations with Congress on a new coronavirus rescue package collapsed. However, the executive order and memorandums ostensibly providing relief amid the intractable coronavirus pandemic don’t seem feasible or legal, analysts said, adding that the wording of the orders raised more questions than the answers provided.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of the White House task force on the coronavirus, has been optimistic on a vaccine arriving at the end of 2020 or in early 2021, and says people must continue to social distance and wear masks.Fauci has said he was hopeful that a coronavirus vaccine could be developed by early 2021, but has previously said it’s unlikely that a vaccine will deliver 100% immunity; he said the best realistic outcome, based on other vaccines, would be 70% to 75% effective.

Michael Osterholm, an epidemiologist at the University of Minnesota who recognized the coronavirus would become a pandemic as early as January, told MarketWatch, “We’re not going to be vaccinating our way out of this to eight-plus billion people in the world right now. And if we don’t get durable immunity, we’re potentially looking at revaccination on a routine basis, if we can do that. We’ve really got to come to grips with actually living with this virus, for at least my lifetime, and at the same time, it doesn’t mean we can’t do a lot about it.”

The Dow Jones Industrial Index DJIA, +1.30% and S&P 500 SPX, +0.27% closed up slightly on Monday as investors awaited progress on round two of a fiscal stimulus during the coronavirus pandemic; the Nasdaq Composite’s COMP, -0.38% closed down Monday.

Related: Feeling lax about masks? Think again. Here’s how many lives could be saved if everyone wore a mask — starting today

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