Rapid Spread of COVID-19 from China to World
November 2019 - March 2020

We review the course of the COVID-19 pandemic. We summarize what we know about the disease spread from its origins in Wuhan, Hubei, China, probably in November 2019. We trace its rapid expansion all over our highly connected world through March 2020. We link to many news and information sources, some of which have further links.

This post reviews the rapid spread of SARS-Cov-2 from China to the world. From its origins in Wuhan, probably in November 2019, we trace the spread of the COVID-19 pandemic all over our highly connected world through March 2020. We link to many news and information sources, some of which have further links.

For additional autoimmune resources please read Useful Basics for Autoimmune Patients around COVID-19, Stories of Self-isolation and Functional Medicine Advice for Autoimmune and Immunocompromised Patients, and important tips on Food Safety.

What is the COVID-19 pandemic?

This timeline is based on many news sources (not all cited), including social media. Genomic analyses of the virus (see NextStrain.org below) also supports a November origin.

A new strain of coronavirus, called SARS-CoV-2 (COVID-19 refers to the disease and the pandemic) emerged in Wuhan, Hubei Province, China. Evidence suggests earliest infections were in mid-November. This remains vague because CCP officials ordered samples, sequences and data destroyed for the earliest weeks of the outbreak. The PRC also prevented scientists from sharing genetic viral sequences until January, 2020. By mid-December, the outbreak was growing exponentially (see link below) throughout Hubei.

November 2019: Wuhan, Hubei, China

Wuhan is a center of industry and research with many connections to the rest of the world. The only Level-4 virus containment laboratory in China is in Wuhan. This lab, which does famous research on bat coronaviruses may have been the source of the outbreak. Wuhan also houses a wet market, where live animals are slaughtered on the spot for human consumption. This includes exotic and endangered species such as bats and pangolins. Whatever the source, before the PRC government admitted they had a problem, travelers for business and the Lunar New Year (last week in January) carried the virus out of China. Since Wuhan is so connected (hub) to trade and social flows of people (spokes), this travel spread the virus to many other hubs in Asia, Europe and the North America before general awareness of the existence of SARS-CoV-2.

Infection is subtle in its earliest stages, especially among younger healthier people (those most likely to be traveling). Update: Infectiousness by asymptomatic people, one of the big surprises of this outbreak, is a big reason for the rapid, undetected spread throughout the pandemic. Thus, many infected people without symptoms (and a few ignoring them!) were unwitting vectors that carried the virus all over the world via land, air and sea. On January 21, the PRC government (i.e., CCP) took drastic action through draconian quarantine of the entire city of Wuhan and then other cities in Hubei.

This long infographic from the South China News (Hong Kong) focuses on China and contains a wealth of information about the virus, the disease and its spread. In addition to the many links in the article, you can also view the daily updates in Coronavirus: the new disease Covid-19 explained.

January 2020:

Middle East

The situation in Iran is dire. The virus infects many senior officials and overwhelms hospitals. The disease spreads from Iran to other hotspots in the Middle East, Europe and North America. 

Europe and UK

Italy’s first confirmed cases (January 31) were directly connected with China, since Milan’s textile industry employs many Chinese workers. Some no doubt, traveled to China for the New Year then returned to Italy. COVID-19 may already have been spreading undetected in December-January, when Northern Italian hospitals were seeing a rise in severe atypical pneumonia cases. Italy is in the worst shape of any European country so far, with a death toll that may have passed China’s (although the PRC’s data is less accurate than Italy’s).

An Austrian ski resort (February – early March) was an early hotspot and hub. From recreational and business travel, the virus has spread to the rest of Europe. Spain has a rapidly growing epidemic, but Denmark seems to have acted quickly to stem growth. The UK, however, seems to be later both in terms of virus spread and instituting mitigation tactics.

Washington State, USA

Patient Zero for the Seattle area hotspot, the first diagnosed US patient, traveled to Wuhan and was out and about for four days after his return before he felt ill, came to an urgent care clinic, was tested and isolated on January 20. He had already passed the virus to some 60 people, an early warning of presymptomatic transmission. Some of his contacts apparently passed it to a nursing home that has been the hottest spot in terms of cases and deaths so far. Staff members from the Kirkland nursing home (which has a history of poor infection control!) then passed it to multiple other nursing homes and into the community at large. Washington State had the highest case numbers in the US, until surpassed by New York in mid-March.

February 2020:

Cruise Ships

Two cruise ships, the Diamond Princess (February 3) and the Grand Princess (February 11-21), were early hotspots. The Diamond Princess was quarantined off Japan, and has provided a natural experiment on how the disease spreads and affects passengers of different ages. Other cruise ships have had outbreaks. 

United States


The Boston hotspot starts with a senior management meeting of 175 people at Biogen (how ironic) February 25-26. Managers from around the world met there, and someone brought the virus too. As anyone who has been to such a meeting can recall, there’s lots of hand-shaking, hugging, and food sharing. An infected person talking or laughing may spread virus through droplets in the air. We now know that aerosols, smaller than droplets) may linger in the air for hours, providing another possible source of infection. Two executives traveled from the Biogen meeting to a financial analyst meeting and infected more people. One flew back to China, because she couldn’t get tested in Boston, hid her symptoms and exposed passengers on the airplane. She is now under arrest in the PRC. 


The USA also has hotspots in the San Francisco Bay Area (includes the Grand Princess, Silicon Valley and Berkeley cases), Sacramento and San Diego. These were seeded at various times in January and February. The UC Davis, Sacramento case was an otherwise healthy woman in her 40s who was admitted with pneumonia in February. She required intensive care and intubation. But she was initially not tested for SARS-CoV-2 because she didn’t meet then-current CDC criteria.

While the low death rate (which has continued through March) offers some comfort, with the current low testing rates and results in California, it is very difficult to trace cases or predict growth. Update: as might be expected from a largely uninfected population, the winter wave in California, especially SoCal, has been nearly as severe as New York was in the spring.

New York City

New York City is a major hub, with many spoke-like connections to the rest of the world. It is currently on a growth trajectory similar to Italy’s. The case rate is understated and fears of overwhelming hospitals and ICUs loom in NYC. Through March, things continued to worsen, with death rates expected to peak in April.

With the delay of widespread testing in the US we do not know how far the disease has spread. Multiply the confirmed case numbers by 10-50 (depending on your model) to get an approximation. As testing ramps up, we will get a clearer picture.

Our next post will provide links to COVID-19 trackers and background on coronaviruses, SARS-COV-2 and basic epidemiological statistics.

Future posts will cover social/physical distancing and other mitigation approaches, testing and protective masks.

Worldwide growth of COVID-19 pandemic.
Worldwide growth of COVID-19 pandemic. http://nrg.cs.ucl.ac.uk/mjh/covid19/

Let us know your thoughts!

The COVID-19 pandemic is a rapidly moving situation. It’s hard to keep ahead of the tsunami of information, misinformation and disinformation. There is also a high noise-to-signal ratio on social media. Let us know in the comments if you have good sources to share, have questions, or if you spot errors or outdated information in our posts. Also if there are additional topics you’d like us to tackle.

Stay well!

Written by: Bonnie Feldman, DDS, MBA, Ellen M. MartinAnnie Rooker


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