title: Al Pacino

text: Pacino has won and been nominated for many awards during his acting career, including nine Oscar nominations (winning one), 18 Golden Globe nominations (winning four), five BAFTA nominations (winning one), two Primetime Emmy Awards for his work on television, and two Tony Awards for his stage work. In 2007, the American Film Institute awarded Pacino with a lifetime achievement award and, in 2003, British television viewers voted Pacino as the greatest film star of all time in a poll for Channel 4.


title: COVID-19

text: Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. The disease quickly spread worldwide, resulting in the COVID-19 pandemic.


title: COVID-19

text: The symptoms of COVID‑19 are variable but often include fever, cough, headache, fatigue, breathing difficulties, loss of smell, and loss of taste. Symptoms may begin one to fourteen days after exposure to the virus. At least a third of people who are infected do not develop noticeable symptoms. Of those who develop symptoms noticeable enough to be classified as patients, most (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging), and 5% develop critical symptoms (respiratory failure, shock, or multiorgan dysfunction). Older people are at a higher risk of developing severe symptoms. Some people continue to experience a range of effects (long COVID) for months after recovery, and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.


title: COVID-19

text: COVID‑19 transmits when people breathe air contaminated by droplets and small airborne particles containing the virus. The risk of breathing these is highest when people are in close proximity, but they can be inhaled over longer distances, particularly indoors. Transmission can also occur if contaminated fluids are splashed or sprayed in the eyes, nose, or mouth, or, more rarely, via contaminated surfaces. People remain contagious for up to 20 days and can spread the virus even if they do not develop symptoms.


title: COVID-19

text: Testing methods for COVID-19 to detect the virus's nucleic acid include real-time reverse transcription polymerase chain reaction (rRTPCR), transcription-mediated amplification, and reverse transcription loop-mediated isothermal amplification (RTLAMP) from a nasopharyngeal swab.


title: COVID-19

text: Several COVID-19 vaccines have been approved and distributed in various countries, which have initiated mass vaccination campaigns. Other preventive measures include physical or social distancing, quarantining, ventilation of indoor spaces, use of face masks or coverings in public, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face. While work is underway to develop drugs that inhibit the virus, the primary treatment is symptomatic. Management involves the treatment of symptoms through supportive care, isolation, and experimental measures.


title: COVID-19

text: During the initial outbreak in Wuhan, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus", with the disease sometimes called "Wuhan pneumonia". In the past, many diseases have been named after geographical locations, such as the Spanish flu, Middle East respiratory syndrome, and Zika virus. In January 2020, the World Health Organization (WHO) recommended 2019-nCoV and 2019-nCoV acute respiratory disease as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations or groups of people in disease and virus names to prevent social stigma. The official names COVID‑19 and SARS-CoV-2 were issued by the WHO on 11 February 2020 with COVID-19 being shorthand for "coronavirus disease 2019". The WHO additionally uses "the COVID‑19 virus" and "the virus responsible for COVID‑19" in public communications.


title: COVID-19

text: COVID‑19 is caused by infection with a strain of coronavirus known as 'Severe Acute Respiratory Syndrome coronavirus 2' (SARS-CoV-2).


title: COVID-19

text: Severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus. It was first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan. All structural features of the novel SARS-CoV-2 virus particle occur in related coronaviruses in nature.


title: COVID-19

text: Outside the human body, the virus is destroyed by household soap, which bursts its protective bubble.


title: COVID-19

text: SARS-CoV-2 is closely related to the original SARS-CoV. It is thought to have an animal (zoonotic) origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus "Betacoronavirus", in subgenus "Sarbecovirus" (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13). The structural proteins of SARS-CoV-2 include membrane glycoprotein (M), envelope protein (E), nucleocapsid protein (N), and the spike protein (S). The M protein of SARS-CoV-2 is about 98% similar to the M protein of bat SARS-CoV, maintains around 98% homology with pangolin SARS-CoV, and has 90% homology with the M protein of SARS-CoV; whereas, the similarity is only around 38% with the M protein of MERS-CoV.


title: COVID-19

text: The many thousands of SARS-CoV-2 variants are grouped into either clades or lineages. The WHO, in collaboration with partners, expert networks, national authorities, institutions and researchers, have established nomenclature systems for naming and tracking SARS-CoV-2 genetic lineages by GISAID, Nextstrain and Pango. The expert group convened by the WHO recommended the labelling of variants using letters of the Greek alphabet, for example, Alpha, Beta, Delta, and Gamma, giving the justification that they "will be easier and more practical to discussed by non-scientific audiences." Nextstrain divides the variants into five clades (19A, 19B, 20A, 20B, and 20C), while GISAID divides them into seven (L, O, V, S, G, GH, and GR). The Pango tool groups variants into lineages, with many circulating lineages being classed under the B.1 lineage.


title: COVID-19

text: Several notable variants of SARS-CoV-2 emerged throughout 2020. Cluster 5 emerged among minks and mink farmers in Denmark. After strict quarantines and a mink euthanasia campaign, the cluster was assessed to no longer be circulating among humans in Denmark as of 1 February 2021.


title: COVID-19

text: , there are five dominant variants of SARS-CoV-2 spreading among global populations: the Alpha variant (B.1.1.7, formerly called the UK variant), first found in London and Kent, the Beta variant (B.1.351, formerly called the South Africa variant), the Gamma variant (P.1, formerly called the Brazil variant), the Delta variant (B.1.617.2, formerly called the India variant), and the Omicron variant (B.1.1.529), which had spread to 57 countries as of 7 December.


title: COVID-19

text: The SARS-CoV-2 virus can infect a wide range of cells and systems of the body. COVID‑19 is most known for affecting the upper respiratory tract (sinuses, nose, and throat) and the lower respiratory tract (windpipe and lungs). The lungs are the organs most affected by COVID‑19 because the virus accesses host cells via the receptor for the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant on the surface of type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" to connect to the ACE2 receptor and enter the host cell.


title: COVID-19

text: Following viral entry, COVID‑19 infects the ciliated epithelium of the nasopharynx and upper airways.


title: COVID-19

text: One common symptom, loss of smell, results from infection of the support cells of the olfactory epithelium, with subsequent damage to the olfactory neurons. The involvement of both the central and peripheral nervous system in COVID‑19 has been reported in many medical publications. It is clear that many people with COVID-19 exhibit neurological or mental health issues. The virus is not detected in the central nervous system (CNS) of the majority of COVID-19 patients with neurological issues. However, SARS-CoV-2 has been detected at low levels in the brains of those who have died from COVID‑19, but these results need to be confirmed. While virus has been detected in cerebrospinal fluid of autopsies, the exact mechanism by which it invades the CNS remains unclear and may first involve invasion of peripheral nerves given the low levels of ACE2 in the brain. The virus may also enter the bloodstream from the lungs and cross the blood–brain barrier to gain access to the CNS, possibly within an infected white blood cell.


title: COVID-19

text: The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium as well as endothelial cells and enterocytes of the small intestine.


title: COVID-19

text: The virus can cause acute myocardial injury and chronic damage to the cardiovascular system. An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China, and is more frequent in severe disease. Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart. ACE2 receptors are highly expressed in the heart and are involved in heart function.


title: COVID-19

text: A high incidence of thrombosis and venous thromboembolism occurs in people transferred to intensive care units with COVID‑19 infections, and may be related to poor prognosis. Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels caused by blood clots) may have a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain found as complications leading to death in people infected with COVID‑19. Infection may initiate a chain of vasoconstrictive responses within the body, including pulmonary vasoconstriction a possible mechanism in which oxygenation decreases during pneumonia. Furthermore, damage of arterioles and capillaries was found in brain tissue samples of people who died from COVID‑19.


title: COVID-19

text: COVID‑19 may also cause substantial structural changes to blood cells, sometimes persisting for months after hospital discharge. A low level of blood lymphocytes may result from the virus acting through ACE2-related entry into lymphocytes.


title: COVID-19

text: Another common cause of death is complications related to the kidneys. Early reports show that up to 30% of hospitalised patients both in China and in New York have experienced some injury to their kidneys, including some persons with no previous kidney problems.


title: COVID-19

text: Autopsies of people who died of COVID‑19 have found diffuse alveolar damage, and lymphocyte-containing inflammatory infiltrates within the lung.


title: COVID-19

text: Although SARS-CoV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, people with severe COVID‑19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL2, IL7, IL6, granulocyte-macrophage colony-stimulating factor (GMCSF), interferon gamma-induced protein10 (IP10), monocyte chemoattractant protein1 (MCP1), macrophage inflammatory protein 1alpha (MIP1alpha), and tumour necrosis factor (TNFα) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology.


title: COVID-19

text: Interferon alpha plays a complex, Janus-faced role in the pathogenesis of COVID-19. Although it promotes the elimination of virus-infected cells, it also upregulates the expression of ACE-2, thereby facilitating the SARS-Cov2 virus to enter cells and to replicate. A competition of negative feedback loops (via protective effects of interferon alpha) and positive feedback loops (via upregulation of ACE-2) is assumed to determine the fate of patients suffering from COVID-19.


title: COVID-19

text: Additionally, people with COVID‑19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and ferritin.


title: COVID-19

text: Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in people with COVID‑19. Lymphocytic infiltrates have also been reported at autopsy.


title: COVID-19

text: Multiple viral and host factors affect the pathogenesis of the virus. The S-protein, otherwise known as the spike protein, is the viral component that attaches to the host receptor via the ACE2 receptors. It includes two subunits: S1 and S2. S1 determines the virus-host range and cellular tropism via the receptor-binding domain. S2 mediates the membrane fusion of the virus to its potential cell host via the H1 and HR2, which are heptad repeat regions. Studies have shown that S1 domain induced IgG and IgA antibody levels at a much higher capacity. It is the focus spike proteins expression that are involved in many effective COVID‑19 vaccines.


title: COVID-19

text: The M protein is the viral protein responsible for the transmembrane transport of nutrients. It is the cause of the bud release and the formation of the viral envelope. The N and E protein are accessory proteins that interfere with the host's immune response.


title: COVID-19

text: Human angiotensin converting enzyme 2 (hACE2) is the host factor that SARS-CoV-2 virus targets causing COVID‑19. Theoretically, the usage of angiotensin receptor blockers (ARB) and ACE inhibitors upregulating ACE2 expression might increase morbidity with COVID‑19, though animal data suggest some potential protective effect of ARB; however no clinical studies have proven susceptibility or outcomes. Until further data is available, guidelines and recommendations for hypertensive patients remain.


title: COVID-19

text: The effect of the virus on ACE2 cell surfaces leads to leukocytic infiltration, increased blood vessel permeability, alveolar wall permeability, as well as decreased secretion of lung surfactants. These effects cause the majority of the respiratory symptoms. However, the aggravation of local inflammation causes a cytokine storm eventually leading to a systemic inflammatory response syndrome.


title: COVID-19

text: Among healthy adults not exposed to SARS-CoV-2, about 35% have CD4 T cells that recognise the SARS-CoV-2 S protein (particularly the S2 subunit) and about 50% react to other proteins of the virus, suggesting cross-reactivity from previous common colds caused by other coronaviruses.


title: COVID-19

text: The severity of the inflammation can be attributed to the severity of what is known as the cytokine storm. Levels of interleukin1B, interferon-gamma, interferon-inducible protein 10, and monocyte chemoattractant protein1 were all associated with COVID‑19 disease severity. Treatment has been proposed to combat the cytokine storm as it remains to be one of the leading causes of morbidity and mortality in COVID‑19 disease.


title: COVID-19

text: A cytokine storm is due to an acute hyperinflammatory response that is responsible for clinical illness in an array of diseases but in COVID‑19, it is related to worse prognosis and increased fatality. The storm causes acute respiratory distress syndrome, blood clotting events such as strokes, myocardial infarction, encephalitis, acute kidney injury, and vasculitis. The production of IL-1, IL-2, IL-6, TNF-alpha, and interferon-gamma, all crucial components of normal immune responses, inadvertently become the causes of a cytokine storm. The cells of the central nervous system, the microglia, neurons, and astrocytes, are also involved in the release of pro-inflammatory cytokines affecting the nervous system, and effects of cytokine storms toward the CNS are not uncommon.


title: COVID-19

text: There are many unknowns for pregnant women during the COVID-19 pandemic. Given that they are prone to have complications and severe disease infection with other types of coronaviruses, they have been identified as a vulnerable group and advised to take supplementary preventive measures.


title: COVID-19

text: However, from the evidence base, it is difficult to conclude whether pregnant women are at increased risk of grave consequences of this virus.


title: COVID-19

text: In addition to the above, other clinical studies have proved that SARS-CoV-2 can affect the period of pregnancy in different ways. On the one hand, there is little evidence of its impact up to 12 weeks gestation. On the other hand, COVID-19 infection may cause increased rates of unfavourable outcomes in the course of the pregnancy. Some examples of these could be foetal growth restriction, preterm birth, and perinatal mortality, which refers to the foetal death past 22 or 28 completed weeks of pregnancy as well as the death among live-born children up to seven completed days of life.


title: COVID-19

text: Unvaccinated women in later stages of pregnancy with COVID-19 are more likely than other patients to need very intensive care. Babies born to mothers with COVID-19 are more likely to have breathing problems. Pregnant women are strongly encouraged to get vaccinated.


title: COVID-19

text: COVID‑19 can provisionally be diagnosed on the basis of symptoms and confirmed using reverse transcription polymerase chain reaction (RT-PCR) or other nucleic acid testing of infected secretions. Along with laboratory testing, chest CT scans may be helpful to diagnose COVID‑19 in individuals with a high clinical suspicion of infection. Detection of a past infection is possible with serological tests, which detect antibodies produced by the body in response to the infection.


title: COVID-19

text: The standard methods of testing for presence of SARS-CoV-2 are nucleic acid tests, which detects the presence of viral RNA fragments. As these tests detect RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited." The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used. Results are generally available within hours. The WHO has published several testing protocols for the disease.


title: COVID-19

text: Several laboratories and companies have developed serological tests, which detect antibodies produced by the body in response to infection. Several have been evaluated by Public Health England and approved for use in the UK.


title: COVID-19

text: The University of Oxford's CEBM has pointed to mounting evidence that "a good proportion of 'new' mild cases and people re-testing positives after quarantine or discharge from hospital are not infectious, but are simply clearing harmless virus particles which their immune system has efficiently dealt with" and have called for "an international effort to standardize and periodically calibrate testing" In September 2020, the UK government issued "guidance for procedures to be implemented in laboratories to provide assurance of positive SARS-CoV-2 RNA results during periods of low prevalence, when there is a reduction in the predictive value of positive test results".


title: COVID-19

text: Chest CT scans may be helpful to diagnose COVID‑19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening. Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection. Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses. Characteristic imaging features on chest radiographs and computed tomography (CT) of people who are symptomatic include asymmetric peripheral ground-glass opacities without pleural effusions.


title: COVID-19

text: Many groups have created COVID‑19 datasets that include imagery such as the Italian Radiological Society which has compiled an international online database of imaging findings for confirmed cases. Due to overlap with other infections such as adenovirus, imaging without confirmation by rRT-PCR is of limited specificity in identifying COVID‑19. A large study in China compared chest CT results to PCR and demonstrated that though imaging is less specific for the infection, it is faster and more sensitive.


title: COVID-19

text: In late 2019, the WHO assigned emergency ICD-10 disease codes U07.1 for deaths from lab-confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed COVID‑19 without lab-confirmed SARS-CoV-2 infection.


title: COVID-19

text: Preventive measures to reduce the chances of infection include getting vaccinated, staying at home, wearing a mask in public, avoiding crowded places, keeping distance from others, ventilating indoor spaces, managing potential exposure durations, washing hands with soap and water often and for at least twenty seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.


title: COVID-19

text: Those diagnosed with COVID‑19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.


title: COVID-19

text: The first COVID‑19 vaccine was granted regulatory approval on 2December 2020 by the UK medicines regulator MHRA. It was evaluated for emergency use authorization (EUA) status by the US FDA, and in several other countries. Initially, the US National Institutes of Health guidelines do not recommend any medication for prevention of COVID‑19, before or after exposure to the SARS-CoV-2 virus, outside the setting of a clinical trial. Without a vaccine, other prophylactic measures, or effective treatments, a key part of managing COVID‑19 is trying to decrease and delay the epidemic peak, known as "flattening the curve". This is done by slowing the infection rate to decrease the risk of health services being overwhelmed, allowing for better treatment of active cases, and delaying additional cases until effective treatments or a vaccine become available.


title: COVID-19

text: The WHO and the US CDC recommend individuals wear non-medical face coverings in public settings where there is an increased risk of transmission and where social distancing measures are difficult to maintain. This recommendation is meant to reduce the spread of the disease by asymptomatic and pre-symptomatic individuals and is complementary to established preventive measures such as social distancing. Face coverings limit the volume and travel distance of expiratory droplets dispersed when talking, breathing, and coughing. A face covering without vents or holes will also filter out particles containing the virus from inhaled and exhaled air, reducing the chances of infection. However, if the mask includes an exhalation valve, a wearer that is infected (and possibly asymptomatic) may transmit the virus through the valve. Many countries and local jurisdictions encourage or mandate the use of face masks or cloth face coverings by members of the public to limit the spread of the virus.


title: COVID-19

text: Masks are also strongly recommended for those who may have been infected and those taking care of someone who may have the disease. When not wearing a mask, the CDC recommends covering the mouth and nose with a tissue when coughing or sneezing and recommends using the inside of the elbow if no tissue is available. Proper hand hygiene after any cough or sneeze is encouraged. Healthcare professionals interacting directly with people who have COVID‑19 are advised to use respirators at least as protective as NIOSH-certified N95 or equivalent, in addition to other personal protective equipment.


title: COVID-19

text: The CDC recommends that crowded indoor spaces should be avoided. When indoors, increasing the rate of air change, decreasing recirculation of air and increasing the use of outdoor air can reduce transmission. The WHO recommends ventilation and air filtration in public spaces to help clear out infectious aerosols.


title: COVID-19

text: Exhaled respiratory particles can build-up within enclosed spaces with inadequate ventilation. The risk of COVID‑19 infection increases especially in spaces where people engage in physical exertion or raise their voice (e.g., exercising, shouting, singing) as this increases exhalation of respiratory droplets. Prolonged exposure to these conditions, typically more than 15 minutes, leads to higher risk of infection.


title: COVID-19

text: Displacement ventilation with large natural inlets can move stale air directly to the exhaust in laminar flow while significantly reducing the concentration of droplets and particles. Passive ventilation reduces energy consumption and maintenance costs but may lack controllability and heat recovery. Displacement ventilation can also be achieved mechanically with higher energy and maintenance costs. The use of large ducts and openings helps to prevent mixing in closed environments. Recirculation and mixing should be avoided because recirculation prevents dilution of harmful particles and redistributes possibly contaminated air, and mixing increases the concentration and range of infectious particles and keeps larger particles in the air.


title: COVID-19

text: Thorough hand hygiene after any cough or sneeze is required. The WHO also recommends that individuals wash hands often with soap and water for at least twenty seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose. When soap and water are not available, the CDC recommends using an alcohol-based hand sanitiser with at least 60% alcohol. For areas where commercial hand sanitisers are not readily available, the WHO provides two formulations for local production. In these formulations, the antimicrobial activity arises from ethanol or isopropanol. Hydrogen peroxide is used to help eliminate bacterial spores in the alcohol; it is "not an active substance for hand antisepsis." Glycerol is added as a humectant.


title: COVID-19

text: Social distancing (also known as physical distancing) includes infection control actions intended to slow the spread of the disease by minimising close contact between individuals. Methods include quarantines; travel restrictions; and the closing of schools, workplaces, stadiums, theatres, or shopping centres. Individuals may apply social distancing methods by staying at home, limiting travel, avoiding crowded areas, using no-contact greetings, and physically distancing themselves from others. Many governments are mandating or recommending social distancing in regions affected by the outbreak.


title: COVID-19

text: Outbreaks have occurred in prisons due to crowding and an inability to enforce adequate social distancing. In the United States, the prisoner population is ageing and many of them are at high risk for poor outcomes from COVID‑19 due to high rates of coexisting heart and lung disease, and poor access to high-quality healthcare.


title: COVID-19

text: After being expelled from the body, coronaviruses can survive on surfaces for hours to days. If a person touches the dirty surface, they may deposit the virus at the eyes, nose, or mouth where it can enter the body and cause infection. Evidence indicates that contact with infected surfaces is not the main driver of COVID‑19, leading to recommendations for optimised disinfection procedures to avoid issues such as the increase of antimicrobial resistance through the use of inappropriate cleaning products and processes. Deep cleaning and other surface sanitation has been criticised as hygiene theatre, giving a false sense of security against something primarily spread through the air.


title: COVID-19

text: The amount of time that the virus can survive depends significantly on the type of surface, the temperature, and the humidity. Coronaviruses die very quickly when exposed to the UV light in sunlight. Like other enveloped viruses, SARS-CoV-2 survives longest when the temperature is at room temperature or lower, and when the relative humidity is low (<50%).


title: COVID-19

text: On many surfaces, including glass, some types of plastic, stainless steel, and skin, the virus can remain infective for several days indoors at room temperature, or even about a week under ideal conditions. On some surfaces, including cotton fabric and copper, the virus usually dies after a few hours. The virus dies faster on porous surfaces than on non-porous surfaces due to capillary action within pores and faster aerosol droplet evaporation. However, of the many surfaces tested, two with the longest survival times are N95 respirator masks and surgical masks, both of which are considered porous surfaces.


title: COVID-19

text: The CDC says that in most situations, cleaning surfaces with soap or detergent, not disinfecting, is enough to reduce risk of transmission. The CDC recommends that if a COVID‑19 case is suspected or confirmed at a facility such as an office or day care, all areas such as offices, bathrooms, common areas, shared electronic equipment like tablets, touch screens, keyboards, remote controls, and ATMs used by the ill persons should be disinfected. Surfaces may be decontaminated with 62–71 per cent ethanol, 50–100 per cent isopropanol, 0.1 per cent sodium hypochlorite, 0.5 per cent hydrogen peroxide, 0.2–7.5 per cent povidone-iodine, or 50–200 ppm hypochlorous acid. Other solutions, such as benzalkonium chloride and chlorhexidine gluconate, are less effective. Ultraviolet germicidal irradiation may also be used, although popular devices require exposure and may deteriorate some materials over time. A datasheet comprising the authorised substances to disinfection in the food industry (including suspension or surface tested, kind of surface, use dilution, disinfectant and inocuylum volumes) can be seen in the supplementary material of.


title: COVID-19

text: Self-isolation at home has been recommended for those diagnosed with COVID‑19 and those who suspect they have been infected. Health agencies have issued detailed instructions for proper self-isolation. Many governments have mandated or recommended self-quarantine for entire populations. The strongest self-quarantine instructions have been issued to those in high-risk groups. Those who may have been exposed to someone with COVID‑19 and those who have recently travelled to a country or region with the widespread transmission have been advised to self-quarantine for 14 days from the time of last possible exposure.


title: COVID-19

text: A 2021 Cochrane rapid review found that based upon low-certainty evidence, international travel-related control measures such as restricting cross-border travel may help to contain the spread of COVID‑19. Additionally, symptom/exposure-based screening measures at borders may miss many positive cases. While test-based border screening measures may be more effective, it could also miss many positive cases if only conducted upon arrival without follow-up. The review concluded that a minimum 10-day quarantine may be beneficial in preventing the spread of COVID‑19 and may be more effective if combined with an additional control measure like border screening.


title: COVID-19

text: The severity of COVID‑19 varies. The disease may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold. In 3–4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalisation. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks. The Italian Istituto Superiore di Sanità reported that the median time between the onset of symptoms and death was twelve days, with seven being hospitalised. However, people transferred to an ICU had a median time of ten days between hospitalisation and death. Abnormal sodium levels during hospitalization with COVID-19 are associated with poor prognoses: high sodium with a greater risk of death, and low sodium with an increased chance of needing ventilator support. Prolonged prothrombin time and elevated C-reactive protein levels on admission to the hospital are associated with severe course of COVID‑19 and with a transfer to ICU.


title: COVID-19

text: Some early studies suggest 10% to 20% of people with COVID‑19 will experience symptoms lasting longer than a month. A majority of those who were admitted to hospital with severe disease report long-term problems including fatigue and shortness of breath. On 30 October 2020, WHO chief Tedros Adhanom warned that "to a significant number of people, the COVID virus poses a range of serious long-term effects." He has described the vast spectrum of COVID‑19 symptoms that fluctuate over time as "really concerning". They range from fatigue, a cough and shortness of breath, to inflammation and injury of major organsincluding the lungs and heart, and also neurological and psychologic effects. Symptoms often overlap and can affect any system in the body. Infected people have reported cyclical bouts of fatigue, headaches, months of complete exhaustion, mood swings, and other symptoms. Tedros therefore concluded that a strategy of achieving herd immunity by infection, rather than vaccination, is "morally unconscionable and unfeasible".


title: COVID-19

text: In terms of hospital readmissions about 9% of 106,000 individuals had to return for hospital treatment within two months of discharge. The average to readmit was eight days since first hospital visit. There are several risk factors that have been identified as being a cause of multiple admissions to a hospital facility. Among these are advanced age (above 65 years of age) and presence of a chronic condition such as diabetes, COPD, heart failure or chronic kidney disease.


title: COVID-19

text: According to scientific reviews smokers are more likely to require intensive care or die compared to non-smokers. Acting on the same ACE2 pulmonary receptors affected by smoking, air pollution has been correlated with the disease. Short term and chronic exposure to air pollution seems to enhance morbidity and mortality from COVID‑19. Pre-existing heart and lung diseases and also obesity, especially in conjunction with fatty liver disease, contributes to an increased health risk of COVID‑19.


title: COVID-19

text: It is also assumed that those that are immunocompromised are at higher risk of getting severely sick from SARS-CoV-2. One research study that looked into the COVID‑19 infections in hospitalised kidney transplant recipients found a mortality rate of 11%.


title: COVID-19

text: Men with untreated hypogonadism were 2.4 times more likely than men with eugonadism to be hospitalized if they contracted COVID-19; Hypogonad men treated with testosterone were less likely to be hospitalized for COVID-19 than men who were not treated for hypogonadism.


title: COVID-19

text: Genetics plays an important role in the ability to fight off Covid. For instance, those that do not produce detectable type I interferons or produce auto-antibodies against these may get much sicker from COVID‑19. Genetic screening is able to detect interferon effector genes. Some genetic variants are risk factors in specific populations. For instance, and allele of the DOCK2 gene (dedicator of cytokinesis 2 gene) is a common risk factor in Asian populations but much less common in Europe. The mutation leads to lower expression of DOCK2 especially in younger patients with severe Covid. In fact, many other genes and genetic variants have been found that determine the outcome of SARS-CoV-2 infections.


title: COVID-19

text: While very young children have experienced lower rates of infection, older children have a rate of infection that is similar to the population as a whole. Children are likely to have milder symptoms and are at lower risk of severe disease than adults. The CDC reports that in the US roughly a third of hospitalised children were admitted to the ICU, while a European multinational study of hospitalised children from June 2020, found that about 8% of children admitted to a hospital needed intensive care. Four of the 582 children (0.7%) in the European study died, but the actual mortality rate may be "substantially lower" since milder cases that did not seek medical help were not included in the study.


title: COVID-19

text: Complications may include pneumonia, acute respiratory distress syndrome (ARDS), multi-organ failure, septic shock, and death. Cardiovascular complications may include heart failure, arrhythmias (including atrial fibrillation), heart inflammation, and thrombosis, particularly venous thromboembolism. Approximately 20–30% of people who present with COVID‑19 have elevated liver enzymes, reflecting liver injury.


title: COVID-19

text: Neurologic manifestations include seizure, stroke, encephalitis, and Guillain–Barré syndrome (which includes loss of motor functions). Following the infection, children may develop paediatric multisystem inflammatory syndrome, which has symptoms similar to Kawasaki disease, which can be fatal. In very rare cases, acute encephalopathy can occur, and it can be considered in those who have been diagnosed with COVID‑19 and have an altered mental status.


title: COVID-19

text: In the case of pregnant women, it is important to note that, according to the US Centers for Disease Control and Prevention, pregnant women are at increased risk of becoming seriously ill from COVID‑19. This is because pregnant women with COVID‑19 appear to be more likely to develop respiratory and obstetric complications that can lead to miscarriage, premature delivery and intrauterine growth restriction.


title: COVID-19

text: Fungal infections such as aspergillosis, candidiasis, cryptococcosis and mucormycosis have been recorded in patients recovering from COVID‑19.


title: COVID-19

text: Some early studies suggest that 10–20% of people with COVID‑19 will experience symptoms lasting longer than a month. A majority of those who were admitted to hospital with severe disease report long-term problems, including fatigue and shortness of breath. About 5–10% of patients admitted to hospital progress to severe or critical disease, including pneumonia and acute respiratory failure.


title: COVID-19

text: By a variety of mechanisms, the lungs are the organs most affected in COVID‑19. In people requiring hospital admission, up to 98% of CT scans performed show lung abnormalities after 28 days of illness even if they had clinically improved.


title: COVID-19

text: People with advanced age, severe disease, prolonged ICU stays, or who smoke are more likely to have long-lasting effects, including pulmonary fibrosis. Overall, approximately one-third of those investigated after four weeks will have findings of pulmonary fibrosis or reduced lung function as measured by DLCO, even in asymptomatic people, but with the suggestion of continuing improvement with the passing of more time. After severe disease, lung function can take anywhere from three months to a year or more to return to previous levels.


title: COVID-19

text: The risks of cognitive deficit, dementia, psychotic disorders, and epilepsy or seizures persists at an increased level two years after infection.


title: COVID-19

text: The immune response by humans to SARS-CoV-2 virus occurs as a combination of the cell-mediated immunity and antibody production, just as with most other infections. B cells interact with T cells and begin dividing before selection into the plasma cell, partly on the basis of their affinity for antigen. Since SARS-CoV-2 has been in the human population only since December 2019, it remains unknown if the immunity is long-lasting in people who recover from the disease. The presence of neutralising antibodies in blood strongly correlates with protection from infection, but the level of neutralising antibody declines with time. Those with asymptomatic or mild disease had undetectable levels of neutralising antibody two months after infection. In another study, the level of neutralising antibodies fell four-fold one to four months after the onset of symptoms. However, the lack of antibodies in the blood does not mean antibodies will not be rapidly produced upon reexposure to SARS-CoV-2. Memory B cells specific for the spike and nucleocapsid proteins of SARS-CoV-2 last for at least six months after the appearance of symptoms.


title: COVID-19

text: As of August 2021, reinfection with COVID‑19 was possible but uncommon. The first case of reinfection was documented in August 2020. A systematic review found 17 cases of confirmed reinfection in medical literature as of May 2021. With the Omicron variant, as of 2022, reinfections have become common, albeit it is unclear how common. COVID-19 reinfections are thought to likely be less severe than primary infections, especially if one was previously infected by the same variant.


title: COVID-19

text: Several measures are commonly used to quantify mortality. These numbers vary by region and over time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics such as age, sex, and overall health.


title: COVID-19

text: The mortality rate reflects the number of deaths within a specific demographic group divided by the population of that demographic group. Consequently, the mortality rate reflects the prevalence as well as the severity of the disease within a given population. Mortality rates are highly correlated to age, with relatively low rates for young people and relatively high rates among the elderly. In fact, one relevant factor of mortality rates is the age structure of the countries' populations. For example, the case fatality rate for COVID‑19 is lower in India than in the US since India's younger population represents a larger percentage than in the US.


title: COVID-19

text: The case fatality rate (CFR) reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is (/) as of . The number varies by region.


title: COVID-19

text: A key metric in gauging the severity of COVID‑19 is the infection fatality rate (IFR), also referred to as the "infection fatality ratio" or "infection fatality risk". This metric is calculated by dividing the total number of deaths from the disease by the total number of infected individuals; hence, in contrast to the CFR, the IFR incorporates asymptomatic and undiagnosed infections as well as reported cases.


title: COVID-19

text: A December 2020 systematic review and meta-analysis estimated that population IFR during the first wave of the pandemic was about 0.5% to 1% in many locations (including France, Netherlands, New Zealand, and Portugal), 1% to 2% in other locations (Australia, England, Lithuania, and Spain), and exceeded 2% in Italy. That study also found that most of these differences in IFR reflected corresponding differences in the age composition of the population and age-specific infection rates; in particular, the metaregression estimate of IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. These results were also highlighted in a December 2020 report issued by the WHO.


title: COVID-19

text: An analysis of those IFR rates indicates that COVID‑19 is hazardous not only for the elderly but also for middle-aged adults, for whom the infection fatality rate of COVID-19 is two orders of magnitude greater than the annualised risk of a fatal automobile accident and far more dangerous than seasonal influenza.


title: COVID-19

text: At an early stage of the pandemic, the World Health Organization reported estimates of IFR between 0.3% and 1%. On 2July, The WHO's chief scientist reported that the average IFR estimate presented at a two-day WHO expert forum was about 0.6%. In August, the WHO found that studies incorporating data from broad serology testing in Europe showed IFR estimates converging at approximately 0.5–1%. Firm lower limits of IFRs have been established in a number of locations such as New York City and Bergamo in Italy since the IFR cannot be less than the population fatality rate. (After sufficient time however, people can get reinfected). As of 10 July, in New York City, with a population of 8.4 million, 23,377 individuals (18,758 confirmed and 4,619 probable) have died with COVID‑19 (0.3% of the population). Antibody testing in New York City suggested an IFR of ≈0.9%, and ≈1.4%. In Bergamo province, 0.6% of the population has died. In September 2020, the U.S. Centers for Disease Control and Prevention (CDC) reported preliminary estimates of age-specific IFRs for public health planning purposes.


title: COVID-19

text: COVID‑19 case fatality rates are higher among men than women in most countries. However, in a few countries like India, Nepal, Vietnam, and Slovenia the fatality cases are higher in women than men. Globally, men are more likely to be admitted to the ICU and more likely to die. One meta-analysis found that globally, men were more likely to get COVID‑19 than women; there were approximately 55 men and 45 women per 100 infections (CI: 51.43–56.58).


title: COVID-19

text: The Chinese Center for Disease Control and Prevention reported the death rate was 2.8% for men and 1.7% for women. Later reviews in June 2020 indicated that there is no significant difference in susceptibility or in CFR between genders. One review acknowledges the different mortality rates in Chinese men, suggesting that it may be attributable to lifestyle choices such as smoking and drinking alcohol rather than genetic factors. Smoking, which in some countries like China is mainly a male activity, is a habit that contributes to increasing significantly the case fatality rates among men. Sex-based immunological differences, lesser prevalence of smoking in women and men developing co-morbid conditions such as hypertension at a younger age than women could have contributed to the higher mortality in men. In Europe as of February 2020, 57% of the infected people were men and 72% of those died with COVID‑19 were men. As of April 2020, the US government is not tracking sex-related data of COVID‑19 infections. Research has shown that viral illnesses like Ebola, HIV, influenza and SARS affect men and women differently.


title: COVID-19

text: In the US, a greater proportion of deaths due to COVID‑19 have occurred among African Americans and other minority groups. Structural factors that prevent them from practising social distancing include their concentration in crowded substandard housing and in "essential" occupations such as retail grocery workers, public transit employees, health-care workers and custodial staff. Greater prevalence of lacking health insurance and care of underlying conditions such as diabetes, hypertension, and heart disease also increase their risk of death. Similar issues affect Native American and Latino communities. On the one hand, in the Dominican Republic there is a clear example of both gender and ethnic inequality. In this Latin American territory, there is great inequality and precariousness that especially affects Dominican women, with greater emphasis on those of Haitian descent. According to a US health policy non-profit, 34% of American Indian and Alaska Native People (AIAN) non-elderly adults are at risk of serious illness compared to 21% of white non-elderly adults. The source attributes it to disproportionately high rates of many health conditions that may put them at higher risk as well as living conditions like lack of access to clean water.


title: COVID-19

text: Leaders have called for efforts to research and address the disparities. In the UK, a greater proportion of deaths due to COVID‑19 have occurred in those of a Black, Asian, and other ethnic minority background. More severe impacts upon patients including the relative incidence of the necessity of hospitalisation requirements, and vulnerability to the disease has been associated via DNA analysis to be expressed in genetic variants at chromosomal region 3, features that are associated with European Neanderthal heritage. That structure imposes greater risks that those affected will develop a more severe form of the disease. The findings are from Professor Svante Pääbo and researchers he leads at the Max Planck Institute for Evolutionary Anthropology and the Karolinska Institutet. This admixture of modern human and Neanderthal genes is estimated to have occurred roughly between 50,000 and 60,000 years ago in Southern Europe.


title: COVID-19

text: Biological factors (immune response) and the general behaviour (habits) can strongly determine the consequences of COVID‑19. Most of those who die of COVID‑19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease. According to March data from the United States, 89% of those hospitalised had preexisting conditions. The Italian Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available, 96.1% of people had at least one comorbidity with the average person having 3.4 diseases. According to this report the most common comorbidities are hypertension (66% of deaths), type 2 diabetes (29.8% of deaths), ischaemic heart disease (27.6% of deaths), atrial fibrillation (23.1% of deaths) and chronic renal failure (20.2% of deaths).


title: COVID-19

text: Most critical respiratory comorbidities according to the US Centers for Disease Control and Prevention (CDC), are: moderate or severe asthma, pre-existing COPD, pulmonary fibrosis, cystic fibrosis. Evidence stemming from meta-analysis of several smaller research papers also suggests that smoking can be associated with worse outcomes. When someone with existing respiratory problems is infected with COVID‑19, they might be at greater risk for severe symptoms. COVID‑19 also poses a greater risk to people who misuse opioids and amphetamines, insofar as their drug use may have caused lung damage.


title: COVID-19

text: In August 2020, the CDC issued a caution that tuberculosis (TB) infections could increase the risk of severe illness or death. The WHO recommended that people with respiratory symptoms be screened for both diseases, as testing positive for COVID‑19 could not rule out co-infections. Some projections have estimated that reduced TB detection due to the pandemic could result in 6.3 million additional TB cases and 1.4 million TB-related deaths by 2025.


title: COVID-19

text: The virus is thought to be of natural animal origin, most likely through spillover infection. A joint-study conducted in early 2021 by the People's Republic of China and the World Health Organization indicated that the virus descended from a coronavirus that infects wild bats, and likely spread to humans through an intermediary wildlife host. There are several theories about where the index case originated and investigations into the origin of the pandemic are ongoing. According to articles published in July 2022 in Science, virus transmission into humans occurred through two spillover events in November 2019 and was likely due to live wildlife trade on the Huanan wet market in the city of Wuhan (Hubei, China). Doubts about the conclusions have mostly centred on the precise site of spillover. Earlier phylogenetics estimated that SARS-CoV-2 arose in October or November 2019. A phylogenetic algorithm analysis suggested that the virus may have been circulating in Guangdong before Wuhan. U.S intelligence agencies and other scientists have found that the virus may have been unintentionally leaked from a laboratory such as the Wuhan Institute of Virology, but that it was not developed as a biological weapon and is unlikely to have been genetically engineered.


title: COVID-19

text: The first confirmed human infections were in Wuhan. A study of the first 41 cases of confirmed COVID‑19, published in January 2020 in "The Lancet", reported the earliest date of onset of symptoms as 1December 2019. Official publications from the WHO reported the earliest onset of symptoms as 8December 2019. Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020. According to official Chinese sources, these were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals. In May 2020, George Gao, the director of the CDC, said animal samples collected from the seafood market had tested negative for the virus, indicating that the market was the site of an early superspreading event, but that it was not the site of the initial outbreak. Traces of the virus have been found in wastewater samples that were collected in Milan and Turin, Italy, on 18 December 2019.


title: COVID-19

text: By December 2019, the spread of infection was almost entirely driven by human-to-human transmission. The number of COVID-19 cases in Hubei gradually increased, reaching sixty by 20 December, and at least 266 by 31 December. On 24 December, Wuhan Central Hospital sent a bronchoalveolar lavage fluid (BAL) sample from an unresolved clinical case to sequencing company Vision Medicals. On 27 and 28 December, Vision Medicals informed the Wuhan Central Hospital and the Chinese CDC of the results of the test, showing a new coronavirus. A pneumonia cluster of unknown cause was observed on 26 December and treated by the doctor Zhang Jixian in Hubei Provincial Hospital, who informed the Wuhan Jianghan CDC on 27 December. On 30 December, a test report addressed to Wuhan Central Hospital, from company CapitalBio Medlab, stated an erroneous positive result for SARS, causing a group of doctors at Wuhan Central Hospital to alert their colleagues and relevant hospital authorities of the result. The Wuhan Municipal Health Commission issued a notice to various medical institutions on "the treatment of pneumonia of unknown cause" that same evening. Eight of these doctors, including Li Wenliang (punished on 3January), were later admonished by the police for spreading false rumours and another, Ai Fen, was reprimanded by her superiors for raising the alarm.


title: COVID-19

text: The Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of unknown cause on 31 December, confirming 27 casesenough to trigger an investigation.


title: COVID-19

text: During the early stages of the outbreak, 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 and Wuhan being a transport hub and major rail interchange. On 20 January, China reported nearly 140 new cases in one day, including two people in Beijing and one in Shenzhen. Later official data shows 6,174 people had already developed symptoms by then, and more may have been infected. A report in "The Lancet" on 24 January indicated human transmission, strongly recommended personal protective equipment for health workers, and said testing for the virus was essential due to its "pandemic potential". On 30 January, the WHO declared COVID-19 a Public Health Emergency of International Concern. By this time, the outbreak spread by a factor of 100 to 200 times.


title: COVID-19

text: Italy had its first confirmed cases on 31 January 2020, two tourists from China. Italy overtook China as the country with the most deaths on 19 March 2020. By 26 March the United States had overtaken China and Italy with the highest number of confirmed cases in the world. Research on coronavirus genomes indicates the majority of COVID-19 cases in New York came from European travellers, rather than directly from China or any other Asian country. Retesting of prior samples found a person in France who had the virus on 27 December 2019, and a person in the United States who died from the disease on 6February 2020.


title: COVID-19

text: RT-PCR testing of untreated wastewater samples from Brazil and Italy have suggested detection of SARS-CoV-2 as early as November and December 2019, respectively, but the methods of such sewage studies have not been optimised, many have not been peer-reviewed, details are often missing, and there is a risk of false positives due to contamination or if only one gene target is detected. A September 2020 review journal article said, "The possibility that the COVID‑19 infection had already spread to Europe at the end of last year is now indicated by abundant, even if partially circumstantial, evidence," including pneumonia case numbers and radiology in France and Italy in November and December.


title: COVID-19

text: , "Reuters" reported that it had estimated the worldwide total number of deaths due to COVID‑19 to have exceeded five million.


title: COVID-19

text: After the initial outbreak of COVID‑19, misinformation and disinformation regarding the origin, scale, prevention, treatment, and other aspects of the disease rapidly spread online.


title: COVID-19

text: In September 2020, the US Centers for Disease Control and Prevention (CDC) published preliminary estimates of the risk of death by age groups in the United States, but those estimates were widely misreported and misunderstood.


title: COVID-19

text: Humans appear to be capable of spreading the virus to some other animals, a type of disease transmission referred to as zooanthroponosis.


title: COVID-19

text: Some pets, especially cats and ferrets, can catch this virus from infected humans. Symptoms in cats include respiratory (such as a cough) and digestive symptoms. Cats can spread the virus to other cats, and may be able to spread the virus to humans, but cat-to-human transmission of SARS-CoV-2 has not been proven. Compared to cats, dogs are less susceptible to this infection. Behaviours which increase the risk of transmission include kissing, licking, and petting the animal.


title: COVID-19

text: The virus does not appear to be able to infect pigs, ducks, or chickens at all. Mice, rats, and rabbits, if they can be infected at all, are unlikely to be involved in spreading the virus.


title: COVID-19

text: Tigers and lions in zoos have become infected as a result of contact with infected humans. As expected, monkeys and great ape species such as orangutans can also be infected with the COVID‑19 virus.


title: COVID-19

text: Minks, which are in the same family as ferrets, have been infected. Minks may be asymptomatic, and can also spread the virus to humans. Multiple countries have identified infected animals in mink farms. Denmark, a major producer of mink pelts, ordered the slaughter of all minks over fears of viral mutations, following an outbreak referred to as Cluster 5. A vaccine for mink and other animals is being researched.


title: COVID-19

text: International research on vaccines and medicines in COVID‑19 is underway by government organisations, academic groups, and industry researchers. The CDC has classified it to require a BSL3 grade laboratory. There has been a great deal of COVID‑19 research, involving accelerated research processes and publishing shortcuts to meet the global demand.


title: COVID-19

text: , hundreds of clinical trials have been undertaken, with research happening on every continent except Antarctica. , more than 200 possible treatments have been studied in humans.


title: COVID-19

text: Modelling research has been conducted with several objectives, including predictions of the dynamics of transmission, diagnosis and prognosis of infection, estimation of the impact of interventions, or allocation of resources. Modelling studies are mostly based on compartmental models in epidemiology, estimating the number of infected people over time under given conditions. Several other types of models have been developed and used during the COVID‑19 including computational fluid dynamics models to study the flow physics of COVID‑19, retrofits of crowd movement models to study occupant exposure, mobility-data based models to investigate transmission, or the use of macroeconomic models to assess the economic impact of the pandemic. Further, conceptual frameworks from crisis management research have been applied to better understand the effects of COVID‑19 on organisations worldwide.


title: COVID-19

text: Repurposed antiviral drugs make up most of the research into COVID‑19 treatments. Other candidates in trials include vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab, and recombinant angiotensin-converting enzyme 2.


title: COVID-19

text: In March 2020, the World Health Organization (WHO) initiated the Solidarity trial to assess the treatment effects of some promising drugs: an experimental drug called remdesivir; anti-malarial drugs chloroquine and hydroxychloroquine; two anti-HIV drugs, lopinavir/ritonavir; and interferon-beta. More than 300 active clinical trials are underway as of April 2020.


title: COVID-19

text: Research on the antimalarial drugs hydroxychloroquine and chloroquine showed that they were ineffective at best, and that they may reduce the antiviral activity of remdesivir. , France, Italy, and Belgium had banned the use of hydroxychloroquine as a COVID‑19 treatment.


title: COVID-19

text: In June, initial results from the randomised RECOVERY Trial in the United Kingdom showed that dexamethasone reduced mortality by one third for people who are critically ill on ventilators and one fifth for those receiving supplemental oxygen. Because this is a well-tested and widely available treatment, it was welcomed by the WHO, which is in the process of updating treatment guidelines to include dexamethasone and other steroids. Based on those preliminary results, dexamethasone treatment has been recommended by the NIH for patients with COVID‑19 who are mechanically ventilated or who require supplemental oxygen but not in patients with COVID‑19 who do not require supplemental oxygen.


title: COVID-19

text: In September 2020, the WHO released updated guidance on using corticosteroids for COVID‑19. The WHO recommends systemic corticosteroids rather than no systemic corticosteroids for the treatment of people with severe and critical COVID‑19 (strong recommendation, based on moderate certainty evidence). The WHO suggests not to use corticosteroids in the treatment of people with non-severe COVID‑19 (conditional recommendation, based on low certainty evidence). The updated guidance was based on a meta-analysis of clinical trials of critically ill COVID‑19 patients.


title: COVID-19

text: In September 2020, the European Medicines Agency (EMA) endorsed the use of dexamethasone in adults and adolescents from twelve years of age and weighing at least who require supplemental oxygen therapy. Dexamethasone can be taken by mouth or given as an injection or infusion (drip) into a vein.


title: COVID-19

text: In November 2020, the US Food and Drug Administration (FDA) issued an emergency use authorization for the investigational monoclonal antibody therapy bamlanivimab for the treatment of mild-to-moderate COVID‑19. Bamlanivimab is authorised for people with positive results of direct SARS-CoV-2 viral testing who are twelve years of age and older weighing at least , and who are at high risk for progressing to severe COVID‑19 or hospitalisation. This includes those who are 65 years of age or older, or who have chronic medical conditions.


title: COVID-19

text: In February 2021, the FDA issued an emergency use authorization (EUA) for bamlanivimab and etesevimab administered together for the treatment of mild to moderate COVID‑19 in people twelve years of age or older weighing at least who test positive for SARS‑CoV‑2 and who are at high risk for progressing to severe COVID‑19. The authorised use includes treatment for those who are 65 years of age or older or who have certain chronic medical conditions.


title: COVID-19

text: In April 2021, the FDA revoked the emergency use authorization (EUA) that allowed for the investigational monoclonal antibody therapy bamlanivimab, when administered alone, to be used for the treatment of mild-to-moderate COVID‑19 in adults and certain paediatric patients.


title: COVID-19

text: A cytokine storm can be a complication in the later stages of severe COVID‑19. A cytokine storm is a potentially deadly immune reaction where a large amount of pro-inflammatory cytokines and chemokines are released too quickly. A cytokine storm can lead to ARDS and multiple organ failure. Data collected from Jin Yin-tan Hospital in Wuhan, China indicates that patients who had more severe responses to COVID‑19 had greater amounts of pro-inflammatory cytokines and chemokines in their system than patients who had milder responses. These high levels of pro-inflammatory cytokines and chemokines indicate presence of a cytokine storm.


title: COVID-19

text: Tocilizumab has been included in treatment guidelines by China's National Health Commission after a small study was completed. It is undergoing a PhaseII non-randomised trial at the national level in Italy after showing positive results in people with severe disease. Combined with a serum ferritin blood test to identify a cytokine storm (also called cytokine storm syndrome, not to be confused with cytokine release syndrome), it is meant to counter such developments, which are thought to be the cause of death in some affected people. The interleukin-6 receptor (IL-6R) antagonist was approved by the FDA to undergo a PhaseIII clinical trial assessing its effectiveness on COVID‑19 based on retrospective case studies for the treatment of steroid-refractory cytokine release syndrome induced by a different cause, CAR T cell therapy, in 2017. There is no randomised, controlled evidence that tocilizumab is an efficacious treatment for CRS. Prophylactic tocilizumab has been shown to increase serum IL-6 levels by saturating the IL-6R, driving IL-6 across the blood–brain barrier, and exacerbating neurotoxicity while having no effect on the incidence of CRS.


title: COVID-19

text: Lenzilumab, an anti-GM-CSF monoclonal antibody, is protective in murine models for CAR T cell-induced CRS and neurotoxicity and is a viable therapeutic option due to the observed increase of pathogenic GM-CSF secreting Tcells in hospitalised patients with COVID‑19.


title: COVID-19

text: Transferring purified and concentrated antibodies produced by the immune systems of those who have recovered from COVID‑19 to people who need them is being investigated as a non-vaccine method of passive immunisation. Viral neutralisation is the anticipated mechanism of action by which passive antibody therapy can mediate defence against SARS-CoV-2. The spike protein of SARS-CoV-2 is the primary target for neutralising antibodies. As of 8August 2020, eight neutralising antibodies targeting the spike protein of SARS-CoV-2 have entered clinical studies. It has been proposed that selection of broad-neutralising antibodies against SARS-CoV-2 and SARS-CoV might be useful for treating not only COVID‑19 but also future SARS-related CoV infections. Other mechanisms, however, such as antibody-dependant cellular cytotoxicity or phagocytosis, may be possible. Other forms of passive antibody therapy, for example, using manufactured monoclonal antibodies, are in development.


title: COVID-19

text: The use of passive antibodies to treat people with active COVID‑19 is also being studied. This involves the production of convalescent serum, which consists of the liquid portion of the blood from people who recovered from the infection and contains antibodies specific to this virus, which is then administered to active patients. This strategy was tried for SARS with inconclusive results. An updated Cochrane review in May 2021 found high certainty evidence that, for the treatment of people with moderate to severe COVID‑19, convalescent plasma did not reduce mortality or bring about symptom improvement. There continues to be uncertainty about the safety of convalescent plasma administration to people with COVID‑19 and differing outcomes measured in different studies limits their use in determining efficacy.


title: COVID-19

text: Since the outbreak of the COVID‑19 pandemic, scholars have explored the bioethics, normative economics, and political theories of healthcare policies related to the public health crisis. Academics have pointed to the moral distress of healthcare workers, ethics of distributing scarce healthcare resources such as ventilators, and the global justice of vaccine diplomacies. The socio-economic inequalities between genders, races, groups with disabilities, communities, regions, countries, and continents have also drawn attention in academia and the general public.


title: COVID-19

text: The use of social distancing and the wearing of surgical masks and similar precautions against COVID‑19 may have caused a drop in the spread of the common cold and the flu.


title: Azerbaijan

text: Azerbaijan (, ; ), officially the Republic of Azerbaijan, is a transcontinental country located at the boundary of Eastern Europe and Western Asia. It is a part of the South Caucasus region and is bounded by the Caspian Sea to the east, Russia (Republic of Dagestan) to the north, Georgia to the northwest, Armenia and Turkey to the west, and Iran to the south. Baku is the capital and largest city.


title: Azerbaijan

text: The Azerbaijan Democratic Republic proclaimed its independence from the Transcaucasian Democratic Federative Republic in 1918 and became the first secular democratic Muslim-majority state. In 1920, the country was incorporated into the Soviet Union as the Azerbaijan SSR. The modern Republic of Azerbaijan proclaimed its independence on 30 August 1991, shortly before the dissolution of the Soviet Union in the same year. In September 1991, the ethnic Armenian majority of the Nagorno-Karabakh region formed the self-proclaimed Republic of Artsakh. The region and seven surrounding districts are internationally recognized as part of Azerbaijan pending a solution to the status of the Nagorno-Karabakh through negotiations facilitated by the OSCE, although became "de facto" independent with the end of the First Nagorno-Karabakh War in 1994. Following the Second Nagorno-Karabakh War in 2020, the seven districts and parts of Nagorno-Karabakh were returned to Azerbaijani control.


title: Azerbaijan

text: Azerbaijan is a unitary semi-presidential republic. It is one of six independent Turkic states and an active member of the Organization of Turkic States and the TÜRKSOY community. Azerbaijan has diplomatic relations with 182 countries and holds membership in 38 international organizations, including the United Nations, the Council of Europe, the Non-Aligned Movement, the OSCE, and the NATO PfP program. It is one of the founding members of GUAM, the CIS, and the OPCW. Azerbaijan is also an observer state of the WTO.


title: Azerbaijan

text: The vast majority of the country's population (97%) is nominally Muslim, but the constitution does not declare an official religion and all major political forces in the country are secularist. Azerbaijan is a developing country and ranks 88th on the Human Development Index. It has a high rate of economic development, literacy, and a low rate of unemployment. However, the ruling New Azerbaijan Party, in power since 1993, has been accused of authoritarian leadership under the leadership of both Heydar Aliyev and his son Ilham Aliyev, and deteriorating the country's human rights record, including increasing restrictions on civil liberties, particularly on press freedom and political repression.


title: Azerbaijan

text: According to a modern etymology, the term "Azerbaijan" derives from that of "Atropates", a Persian satrap under the Achaemenid Empire, who was later reinstated as the satrap of Media under Alexander the Great. The original etymology of this name is thought to have its roots in the once-dominant Zoroastrianism. In the Avesta's "Frawardin Yasht" ("Hymn to the Guardian Angels"), there is a mention of , which literally translates from Avestan as "we worship the fravashi of the holy Atropatene". The name "Atropates" itself is the Greek transliteration of an Old Iranian, probably Median, compounded name with the meaning "Protected by the (Holy) Fire" or "The Land of the (Holy) Fire". The Greek name was mentioned by Diodorus Siculus and Strabo. Over the span of millennia, the name evolved to (Middle Persian), then to , , (New Persian) and present-day "Azerbaijan".


title: Azerbaijan

text: The name "Azerbaijan" was first adopted for the area of the present-day Republic of Azerbaijan by the government of Musavat in 1918, after the collapse of the Russian Empire, when the independent Azerbaijan Democratic Republic was established. Until then, the designation had been used exclusively to identify the adjacent region of contemporary northwestern Iran, while the area of the Azerbaijan Democratic Republic was formerly referred to as "Arran" and "Shirvan". On that basis Iran protested the newly adopted country name.


title: Azerbaijan

text: During the Soviet rule, the country was also spelled in Latin from the Russian transliteration as ' (). The country's name was also spelled in Cyrillic script from 1940 to 1991 as '.


title: Azerbaijan

text: The earliest evidence of human settlement in the territory of Azerbaijan dates back to the late Stone Age and is related to the Guruchay culture of Azykh Cave.


title: Azerbaijan

text: Early settlements included the Scythians during the 9th century BC. Following the Scythians, Iranian Medes came to dominate the area to the south of the Aras river. The Medes forged a vast empire between 900 and 700 BC, which was integrated into the Achaemenid Empire around 550 BC. The area was conquered by the Achaemenids leading to the spread of Zoroastrianism.


title: Azerbaijan

text: The Sasanian Empire turned Caucasian Albania into a vassal state in 252, while King Urnayr officially adopted Christianity as the state religion in the 4th century. Despite Sassanid rule, Albania remained an entity in the region until the 9th century, while fully subordinate to Sassanid Iran, and retained its monarchy. Despite being one of the chief vassals of the Sasanian emperor, the Albanian king had only a semblance of authority, and the Sasanian marzban (military governor) held most civil, religious, and military authority.


title: Azerbaijan

text: In the first half of the 7th century, Caucasian Albania, as a vassal of the Sasanians, came under nominal Muslim rule due to the Muslim conquest of Persia. The Umayyad Caliphate repulsed both the Sasanians and Byzantines from the South Caucasus and turned Caucasian Albania into a vassal state after Christian resistance led by King Javanshir was suppressed in 667. The power vacuum left by the decline of the Abbasid Caliphate was filled by numerous local dynasties such as the Sallarids, Sajids, and Shaddadids. At the beginning of the 11th century, the territory was gradually seized by the waves of Oghuz Turks from Central Asia, who adopted a Turkoman ethnonym at the time. The first of these Turkic dynasties established was the Seljuk Empire, which entered the area now known as Azerbaijan by 1067.


title: Azerbaijan

text: The pre-Turkic population that lived on the territory of modern Azerbaijan spoke several Indo-European and Caucasian languages, among them Armenian and an Iranian language, Old Azeri, which was gradually replaced by a Turkic language, the early precursor of the Azerbaijani language of today. Some linguists have also stated that the Tati dialects of Iranian Azerbaijan and the Republic of Azerbaijan, like those spoken by the Tats, are descended from Old Azeri.


title: Azerbaijan

text: Locally, the possessions of the subsequent Seljuk Empire were ruled by Eldiguzids, technically vassals of the Seljuk sultans, but sometimes "de facto" rulers themselves. Under the Seljuks, local poets such as Nizami Ganjavi and Khaqani gave rise to a blossoming of Persian literature on the territory of present-day Azerbaijan.


title: Azerbaijan

text: The local dynasty of the Shirvanshahs became a vassal state of Timur's empire and assisted him in his war with the ruler of the Golden Horde Tokhtamysh. Following Timur's death, two independent and rival states emerged: Qara Qoyunlu and Aq Qoyunlu. The Shirvanshahs returned, maintaining for numerous centuries to come a high degree of autonomy as local rulers and vassals as they had done since 861. In 1501, the Safavid dynasty of Iran subdued the Shirvanshahs and gained its possessions. In the course of the next century, the Safavids converted the formerly Sunni population to Shia Islam, as they did with the population in what is modern-day Iran. The Safavids allowed the Shirvanshahs to remain in power, under Safavid suzerainty, until 1538, when Safavid king Tahmasp I (r. 1524–1576) completely deposed them, and made the area into the Safavid province of Shirvan. The Sunni Ottomans briefly managed to occupy parts of present-day Azerbaijan as a result of the Ottoman–Safavid War of 1578–1590; by the early 17th century, they were ousted by Safavid Iranian ruler Abbas I (r. 1588–1629). In the wake of the demise of the Safavid Empire, Baku and its environs were briefly occupied by the Russians as a consequence of the Russo-Persian War of 1722–1723. Despite brief intermissions such as these by Safavid Iran's neighboring rivals, the land of what is today Azerbaijan remained under Iranian rule from the earliest advent of the Safavids up to the course of the 19th century.


title: Azerbaijan

text: After the Safavids, the area was ruled by the Iranian Afsharid dynasty. After the death of Nader Shah (r. 1736–1747), many of his former subjects capitalized on the eruption of instability. Numerous self-ruling khanates with various forms of autonomy emerged in the area. The rulers of these khanates were directly related to the ruling dynasties of Iran and were vassals and subjects of the Iranian shah. The khanates exercised control over their affairs via international trade routes between Central Asia and the West.


title: Azerbaijan

text: Thereafter, the area was under the successive rule of the Iranian Zands and Qajars. From the late 18th century, Imperial Russia switched to a more aggressive geo-political stance towards its two neighbors and rivals to the south, namely Iran and the Ottoman Empire. Russia now actively tried to gain possession of the Caucasus region which was, for the most part, in the hands of Iran. In 1804, the Russians invaded and sacked the Iranian town of Ganja, sparking the Russo-Persian War of 1804–1813. The militarily superior Russians ended the Russo-Persian War of 1804–1813 with a victory.


title: Azerbaijan

text: Following Qajar Iran's loss in the 1804–1813 war, it was forced to concede suzerainty over most of the khanates, along with Georgia and Dagestan to the Russian Empire, per the Treaty of Gulistan.


title: Azerbaijan

text: The area to the north of the river Aras, amongst which territory lies the contemporary Republic of Azerbaijan, was Iranian territory until Russia occupied it in the 19th century. About a decade later, in violation of the Gulistan treaty, the Russians invaded Iran's Erivan Khanate. This sparked the final bout of hostilities between the two, the Russo-Persian War of 1826–1828. The resulting Treaty of Turkmenchay, forced Qajar Iran to cede sovereignty over the Erivan Khanate, the Nakhchivan Khanate and the remainder of the Talysh Khanate, comprising the last parts of the soil of the contemporary Azerbaijani Republic that were still in Iranian hands. After the incorporation of all Caucasian territories from Iran into Russia, the new border between the two was set at the Aras River, which, upon the Soviet Union's disintegration, subsequently became part of the border between Iran and the Azerbaijan Republic.


title: Azerbaijan

text: Qajar Iran was forced to cede its Caucasian territories to Russia in the 19th century, which thus included the territory of the modern-day Azerbaijan Republic, while as a result of that cession, the Azerbaijani ethnic group is nowadays parted between two nations: Iran and Azerbaijan.


title: Azerbaijan

text: Despite the Russian conquest, throughout the entire 19th century, preoccupation with Iranian culture, literature, and language remained widespread amongst Shia and Sunni intellectuals in the Russian-held cities of Baku, Ganja and Tiflis (Tbilisi, now Georgia). Within the same century, in post-Iranian Russian-held East Caucasia, an Azerbaijani national identity emerged at the end of the 19th century.


title: Azerbaijan

text: After the collapse of the Russian Empire during World War I, the short-lived Transcaucasian Democratic Federative Republic was declared, constituting the present-day republics of Azerbaijan, Georgia, and Armenia.


title: Azerbaijan

text: It was followed by the March Days massacres that took place between 30 March and 2 April 1918 in the city of Baku and adjacent areas of the Baku Governorate of the Russian Empire. When the republic dissolved in May 1918, the leading Musavat party declared independence as the Azerbaijan Democratic Republic (ADR), adopting the name of "Azerbaijan" for the new republic; a name that prior to the proclamation of the ADR was solely used to refer to the adjacent northwestern region of contemporary Iran. The ADR was the first modern parliamentary republic in the Muslim world. Among the important accomplishments of the Parliament was the extension of suffrage to women, making Azerbaijan the first Muslim nation to grant women equal political rights with men. Another important accomplishment of ADR was the establishment of Baku State University, which was the first modern-type university founded in the Muslim East.


title: Azerbaijan

text: By March 1920, it was obvious that Soviet Russia would attack Baku. Vladimir Lenin said that the invasion was justified as Soviet Russia could not survive without Baku's oil. Independent Azerbaijan lasted only 23 months until the Bolshevik 11th Soviet Red Army invaded it, establishing the Azerbaijan SSR on 28 April 1920. Although the bulk of the newly formed Azerbaijani army was engaged in putting down an Armenian revolt that had just broken out in Karabakh, Azerbaijanis did not surrender their brief independence of 1918–20 quickly or easily. As many as 20,000 Azerbaijani soldiers died resisting what was effectively a Russian reconquest. Within the ensuing early Soviet period, the Azerbaijani national identity was finally forged.


title: Azerbaijan

text: On 13 October 1921, the Soviet republics of Russia, Armenia, Azerbaijan, and Georgia signed an agreement with Turkey known as the Treaty of Kars. The previously independent Republic of Aras would also become the Nakhchivan Autonomous Soviet Socialist Republic within the Azerbaijan SSR by the treaty of Kars. On the other hand, Armenia was awarded the region of Zangezur and Turkey agreed to return Gyumri (then known as Alexandropol).


title: Azerbaijan

text: During World War II, Azerbaijan played a crucial role in the strategic energy policy of the Soviet Union, with 80 percent of the Soviet Union's oil on the Eastern Front being supplied by Baku. By the Decree of the Supreme Soviet of the USSR in February 1942, the commitment of more than 500 workers and employees of the oil industry of Azerbaijan were awarded orders and medals. Operation Edelweiss carried out by the German Wehrmacht targeted Baku because of its importance as the energy (petroleum) dynamo of the USSR. A fifth of all Azerbaijanis fought in the Second World War from 1941 to 1945. Approximately 681,000 people with over 100,000 of them women, went to the front, while the total population of Azerbaijan was 3.4 million at the time. Some 250,000 people from Azerbaijan were killed on the front. More than 130 Azerbaijanis were named Heroes of the Soviet Union. Azerbaijani Major-General Azi Aslanov was twice awarded the Hero of the Soviet Union.


title: Azerbaijan

text: Following the politics of "glasnost", initiated by Mikhail Gorbachev, civil unrest and ethnic strife grew in various regions of the Soviet Union, including Nagorno-Karabakh, an autonomous region of the Azerbaijan SSR. The disturbances in Azerbaijan, in response to Moscow's indifference to an already heated conflict, resulted in calls for independence and secession, which culminated in the Black January events in Baku. Later in 1990, the Supreme Council of the Azerbaijan SSR dropped the words "Soviet Socialist" from the title, adopted the "Declaration of Sovereignty of the Azerbaijan Republic" and restored the flag of the Azerbaijan Democratic Republic as the state flag. As a consequence of the failed 1991 Soviet coup d'état attempt in Moscow, the Supreme Council of Azerbaijan adopted a Declaration of Independence on 18 October 1991, which was affirmed by a nationwide referendum in December 1991, while the Soviet Union officially ceased to exist on 26 December 1991. The country now celebrates its Independence Day on 18 October.


title: Azerbaijan

text: The early years of independence were overshadowed by the First Nagorno-Karabakh war with the ethnic Armenian majority of Nagorno-Karabakh backed by Armenia. By the end of the hostilities in 1994, Armenians controlled up to 14–16 percent of Azerbaijani territory, including Nagorno-Karabakh itself. During the war many atrocities and pogroms by both sides were committed including the massacres at Malibeyli and Gushchular, the Garadaghly massacre and the Khojaly massacres, along with the Baku pogrom, the Maraga massacre and the Kirovabad pogrom. Furthermore, an estimated 30,000 people have been killed and more than a million people have been displaced, more than 800,000 Azerbaijanis and 300,000 Armenians. Four United Nations Security Council Resolutions (822, 853, 874, and 884) demand for "the immediate withdrawal of all Armenian forces from all occupied territories of Azerbaijan." Many Russians and Armenians left and fled Azerbaijan as refugees during the 1990s. According to the 1970 census, there were 510,000 ethnic Russians and 484,000 Armenians in Azerbaijan.


title: Azerbaijan

text: In 1993, democratically elected president Abulfaz Elchibey was overthrown by a military insurrection led by Colonel Surat Huseynov, which resulted in the rise to power of the former leader of Soviet Azerbaijan, Heydar Aliyev. In 1994, Surat Huseynov, by that time the prime minister, attempted another military coup against Heydar Aliyev, but he was arrested and charged with treason. A year later, in 1995, another coup was attempted against Aliyev, this time by the commander of the OMON special unit, Rovshan Javadov. The coup was averted, resulting in the killing of the latter and disbanding of Azerbaijan's OMON units. At the same time, the country was tainted by rampant corruption in the governing bureaucracy. In October 1998, Aliyev was reelected for a second term. Despite the much improved economy, particularly with the exploitation of the Azeri–Chirag–Guneshli oil field and Shah Deniz gas field, Aliyev's presidency was criticized due to suspected election fraud, high levels of economic inequality and domestic corruption.


title: Azerbaijan

text: Ilham Aliyev, Heydar Aliyev's son, became chairman of the New Azerbaijan Party as well as President of Azerbaijan when his father died in 2003. He was reelected to a third term as president in October 2013. In April 2018, President Ilham Aliyev secured his fourth consecutive term in the election that was boycotted by the main opposition parties as fraudulent. On 27 September 2020, new clashes in the unresolved Nagorno-Karabakh conflict resumed along the Nagorno-Karabakh Line of Contact. Both the armed forces of Azerbaijan and Armenia reported military and civilian casualties. The Nagorno-Karabakh ceasefire agreement and the end of the six-week war between Azerbaijan and Armenia was widely celebrated in Azerbaijan, as they made significant territorial gains.


title: Azerbaijan

text: Geographically, Azerbaijan is located in the South Caucasus region of Eurasia, straddling Western Asia and Eastern Europe. It lies between latitudes 38° and 42° N, and longitudes 44° and 51° E. The total length of Azerbaijan's land borders is , of which are with Armenia, with Iran, 480 kilometers with Georgia, with Russia and with Turkey. The coastline stretches for , and the length of the widest area of the Azerbaijani section of the Caspian Sea is . The country has a landlocked exclave, the Nakhchivan Autonomous Republic.


title: Azerbaijan

text: Three physical features dominate Azerbaijan: the Caspian Sea, whose shoreline forms a natural boundary to the east; the Greater Caucasus mountain range to the north; and the extensive flatlands at the country's center. There are also three mountain ranges, the Greater and Lesser Caucasus, and the Talysh Mountains, together covering approximately 40% of the country. The highest peak of Azerbaijan is Mount Bazardüzü , while the lowest point lies in the Caspian Sea . Nearly half of all the mud volcanoes on Earth are concentrated in Azerbaijan, these volcanoes were also among nominees for the New7Wonders of Nature.


title: Azerbaijan

text: The main water sources are surface waters. Only 24 of the 8,350 rivers are greater than in length. All the rivers drain into the Caspian Sea in the east of the country. The largest lake is Sarysu , and the longest river is Kur , which is transboundary with Armenia. Azerbaijan has several islands along the Caspian sea, mostly located in the Baku Archipelago.


title: Azerbaijan

text: Since the independence of Azerbaijan in 1991, the Azerbaijani government has taken measures to preserve the environment of Azerbaijan. National protection of the environment accelerated after 2001 when the state budget increased due to new revenues provided by the Baku–Tbilisi–Ceyhan pipeline. Within four years, protected areas doubled and now make up eight percent of the country's territory. Since 2001 the government has set up seven large reserves and almost doubled the sector of the budget earmarked for environmental protection.


title: Azerbaijan

text: Azerbaijan is home to a wide variety of landscapes. Over half of Azerbaijan's landmass consists of mountain ridges, crests, highlands, and plateaus which rise up to hypsometric levels of 400–1000 meters (including the Middle and Lower lowlands), in some places (Talis, Jeyranchol-Ajinohur and Langabiz-Alat foreranges) up to 100–120 meters, and others from 0–50 meters and up (Qobustan, Absheron). The rest of Azerbaijan's terrain consists of plains and lowlands. Hypsometric marks within the Caucasus region vary from about −28 meters at the Caspian Sea shoreline up to 4,466 meters (Bazardüzü peak).


title: Azerbaijan

text: The formation of climate in Azerbaijan is influenced particularly by cold arctic air masses of Scandinavian anticyclone, temperate air masses of Siberian anticyclone, and Central Asian anticyclone. Azerbaijan's diverse landscape affects the ways air masses enter the country. The Greater Caucasus protects the country from direct influences of cold air masses coming from the north. That leads to the formation of subtropical climate on most foothills and plains of the country. Meanwhile, plains and foothills are characterized by high solar radiation rates.


title: Azerbaijan

text: Nine out of eleven existing climate zones are present in Azerbaijan. Both the absolute minimum temperature ( ) and the absolute maximum temperature were observed in Julfa and Ordubad – regions of Nakhchivan Autonomous Republic. The maximum annual precipitation falls in Lankaran () and the minimum in Absheron ().


title: Azerbaijan

text: Rivers and lakes form the principal part of the water systems of Azerbaijan, they were formed over a long geological timeframe and changed significantly throughout that period. This is particularly evidenced by remnants of ancient rivers found throughout the country. The country's water systems are continually changing under the influence of natural forces and human-introduced industrial activities. Artificial rivers (canals) and ponds are a part of Azerbaijan's water systems. In terms of water supply, Azerbaijan is below the average in the world with approximately per year of water per square kilometer. All big water reservoirs are built on Kur. The hydrography of Azerbaijan basically belongs to the Caspian Sea basin.


title: Azerbaijan

text: The Kura and Aras are the major rivers in Azerbaijan. They run through the Kura-Aras Lowland. The rivers that directly flow into the Caspian Sea, originate mainly from the north-eastern slope of the Major Caucasus and Talysh Mountains and run along the Samur–Devechi and Lankaran lowlands.


title: Azerbaijan

text: Yanar Dag, translated as "burning mountain", is a natural gas fire which blazes continuously on a hillside on the Absheron Peninsula on the Caspian Sea near Baku, which itself is known as the "land of fire." Flames jet out into the air from a thin, porous sandstone layer. It is a tourist attraction to visitors to the Baku area.


title: Azerbaijan

text: The first reports on the richness and diversity of animal life in Azerbaijan can be found in travel notes of Eastern travelers. Animal carvings on architectural monuments, ancient rocks, and stones survived up to the present times. The first information on flora and fauna of Azerbaijan was collected during the visits of naturalists to Azerbaijan in the 17th century.


title: Azerbaijan

text: There are 106 species of mammals, 97 species of fish, 363 species of birds, 10 species of amphibians, and 52 species of reptiles which have been recorded and classified in Azerbaijan. The national animal of Azerbaijan is the Karabakh horse, a mountain-steppe racing and riding horse endemic to Azerbaijan. The Karabakh horse has a reputation for its good temper, speed, elegance, and intelligence. It is one of the oldest breeds, with ancestry dating to the ancient world, but today the horse is an endangered species.


title: Azerbaijan

text: Azerbaijan's flora consists of more than 4,500 species of higher plants. Due to the unique climate in Azerbaijan, the flora is much richer in the number of species than the flora of the other republics of the South Caucasus. 66 percent of the species growing in the whole Caucasus can be found in Azerbaijan. The country lies within four ecoregions: Caspian Hyrcanian mixed forests, Caucasus mixed forests, Eastern Anatolian montane steppe, and Azerbaijan shrub desert and steppe. Azerbaijan had a 2018 Forest Landscape Integrity Index mean score of 6.55/10, ranking it 72nd globally out of 172 countries.


title: Azerbaijan

text: The structural formation of Azerbaijan's political system was completed by the adoption of the new Constitution on 12 November 1995. According to Article 23 of the Constitution, the state symbols of the Azerbaijan Republic are the flag, the coat of arms, and the national anthem. The state power in Azerbaijan is limited only by law for internal issues, but international affairs are also limited by international agreements' provisions.


title: Azerbaijan

text: The Constitution of Azerbaijan states that it is a presidential republic with three branches of power – Executive, Legislative, and Judicial. The legislative power is held by the unicameral National Assembly and the Supreme National Assembly in the Nakhchivan Autonomous Republic. The Parliament of Azerbaijan, called Milli Majlis, consists of 125 deputies elected based on majority vote, with a term of five years for each elected member. The elections are held every five years, on the first Sunday of November. The Parliament is not responsible for the formation of the government, but the Constitution requires the approval of the Cabinet of Ministers by Milli Majlis. The New Azerbaijan Party, and independents loyal to the ruling government, currently hold almost all of the Parliament's 125 seats. During the 2010 Parliamentary election, the opposition parties, Musavat and Azerbaijani Popular Front Party, failed to win a single seat. European observers found numerous irregularities in the run-up to the election and on election day.


title: Azerbaijan

text: The executive power is held by the President, who is elected for a seven-year term by direct elections, and the Prime Minister. The president is authorized to form the Cabinet, a collective executive body accountable to both the President and the National Assembly. The Cabinet of Azerbaijan consists primarily of the prime minister, his deputies, and ministers. The 8th Government of Azerbaijan is the administration in its current formation. The president does not have the right to dissolve the National Assembly but has the right to veto its decisions. To override the presidential veto, the parliament must have a majority of 95 votes. The judicial power is vested in the Constitutional Court, Supreme Court, and the Economic Court. The president nominates the judges in these courts. The European Commission for the Efficiency of Justice (CEPEJ) report refers to the Azerbaijani justice model on the selection of new judges as best practice, reflecting the particular features and the course of development towards ensuring the independence and quality of the judiciary in a new democracy.