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COVID-19 PANDEMIC

COVID-19 Pandemic

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This transmission electron microscope image shows SARS-CoV-2—also known as 2019-nCoV, the virus that causes COVID-19—isolated from a patient in the U.S. Virus particles are shown emerging from the surface of cells cultured in the lab. The spikes on the outer edge of the virus particles give coronaviruses their name, crown-like.

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case was identified in Wuhan, China, in December 2019. It has since spread worldwide, leading to an ongoing pandemic.

Symptoms of COVID-19 are variable, but often include fever, cough, fatigue, breathing difficulties, and loss of smell and taste. Symptoms begin one to fourteen days after exposure to the virus. Around one in five infected individuals do not develop any symptoms.[1] While most people have mild symptoms, some people develop acute respiratory distress syndrome (ARDS). ARDS can be precipitated by cytokine storms,[2] multi-organ failure, septic shock, and blood clots. Longer-term damage to organs (in particular, the lungs and heart) has been observed. There is concern about a significant number of patients who have recovered from the acute phase of the disease but continue to experience a range of effects—known as long COVID—for months afterwards. These effects include severe fatigue, memory loss and other cognitive issues, low-grade fever, muscle weakness, and breathlessness.[3][4][5][6]

The virus that causes COVID-19 spreads mainly when an infected person is in close contact[a] with another person.[10][11] Small droplets and aerosols containing the virus can spread from an infected person's nose and mouth as they breathe, cough, sneeze, sing, or speak. Other people are infected if the virus gets into their mouth, nose or eyes. The virus may also spread via contaminated surfaces, although this is not thought to be the main route of transmission.[11] The exact route of transmission is rarely proven conclusively,[12] but infection mainly happens when people are near each other for long enough. It can spread as early as two days before infected persons show symptoms, and from individuals who never experience symptoms. People remain infectious for up to ten days in moderate cases, and two weeks in severe cases. Various testing methods have been developed to diagnose the disease. The standard diagnosis method is by real-time reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab.

Preventive measures include physical or social distancing, quarantining, ventilation of indoor spaces, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face. The use of face masks or coverings has been recommended in public settings to minimise the risk of transmissions. Several vaccines have been developed and various countries have initiated mass vaccination campaigns.

Although work is underway to develop drugs that inhibit the virus, the primary treatment is currently symptomatic. Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.

Treatments

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Remdesivir
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As of late October, 2020, remdesivir was the only drug in the United States approved by the FDA with a specific indication to treat COVID-19.[13][14][15]

In November 2020, the World Health Organization (WHO) made a conditional recommendation against treatment with remdesivir for hospitalized patients, regardless of severity (based on data from the Solidarity Trial).[16]

Immunotherapy
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In January 2021 in the United Kingdom, the National Health Service issued guidance that the immune modulating drugs tocilizumab and sarilumab were beneficial when given promptly to people with COVID-19 admitted to intensive care, following research which found a reduction in the risk of death by 24%.[17]

Baricitinib
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In November 2020, the FDA granted Emergency use authorization (EUA)[b] for the drug baricitinib to be given to certain people hospitalised with suspected or confirmed COVID-19, but only in conjunction with remdesivir.[18] In a single clinical trial, this combination therapy was shown to have a small, but statistically significant effect on patient outcomes compared to administration of remdesivir alone.[19] Use of baricitinib was restricted to adults and children two years of age or older requiring supplemental oxygen, mechanical ventilation, or ECMO.[18]

Dexamethasone
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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 40 kg) who require supplemental oxygen therapy.[20]

Pfizer Vaccine
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The Pfizer BioTech COVID-19 Vaccine is used or the prevention of 2019 coronavirus disease (COVID-19) for individuals 16 years of age and older. The most commonly reported side effects, which typically lasted several days, were pain at the injection site, tiredness, headache, muscle pain, chills, joint pain, and fever. Of note, more people experienced these side effects after the second dose than after the first dose, so it is important for vaccination providers and recipients to expect that there may be some side effects after either dose, but even more so after the second dose. [21] The vaccine is shot in the muscle of the upper left arm, and is taken in two doses, 21 days apart. The FDA approved the vaccine on December 11, 2020.[21]

Moderna Vaccine
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mRNA-1273, more commonly known as the Moderna COVID-19 vaccine, is a COVID-19 vaccine developed by the National Institute of Allergy and Infectious Diseases (NIAID), the Biomedical Advanced Research and Development Authority (BARDA), and Moderna. It is administered by two 0.5 mL doses given by intramuscular injection given four weeks apart.

On 18 December 2020, mRNA-1273 was issued an Emergency Use Authorization by the United States Food and Drug Administration (FDA). It was authorized for use in Canada on 23 December 2020, in the European Union on 6 January 2021, and in the United Kingdom on 8 January 2021.

Johnson and Johnson vaccine
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The Johnson & Johnson COVID-19 vaccine is a human adenovirus viral vector COVID-19 vaccine developed by Janssen Pharmaceuticals, a subsidiary of American company Johnson & Johnson (J&J).[22]

AstraZeneca Vaccine
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The Oxford–AstraZeneca COVID-19 vaccine, codenamed AZD1222 and marketed as Covishield in India, is a COVID-19 vaccine developed by Oxford University and AstraZeneca given by intramuscular injection, using as a vector the modified chimpanzee adenovirus ChAdOx1. One dosing regimen showed 90% efficacy when a half-dose was followed by a full-dose after at least one month, based on mixed trials with no participants over 55 years old. Another dosing regimen showed 62% efficacy when given as two full doses separated by at least one month.

The War on ISIL (December 2013-Present).

On February 3, 2014, the Islamic State of Iraq and the Levant (also known by the acronym ISIS or ISIL), formerly known as al-Qaeda in Iraq, split from al-Qaeda and began a massive military campaign to conquer the entire region of the Levant and Greater Syria, causing thousands of civilians in Iraq and Syria to flee their homes. ISIL's campaigns also brought it into conflict with the al-Nusra Front, or al-Qaeda in Syria, despite several local truces and joint military operations at times.

On June 29, 2014, ISIL renamed itself to simply the Islamic State and declared itself to be a Worldwide Caliphate, with Abu Bakr al-Baghdadi as its Caliph, and claimed the entire world as its territory. ISIL then increased its campaigns in Iraq and Syria, conquering over a third of each country, and force 16 million people to live under its harsh version of Sharia rule. The ensuing conflicts caused over 400,000 Syrian civilians to flee to Turkey, to escape advancing ISIL forces. ISIL also managed to expand into Turkey, Lebanon, Libya, the Gaza Strip, the Sinai Peninsula, Pakistan, and the Philippines, mainly through pledges of allegiance from other terrorist groups already present in those countries (usually al-Qaeda branches). This prompted the United States to lead a Anti-ISIL coalition in an international military campaign against ISIL, in an attempt to destabilize and destroy the terrorist organization before it grew out of control.

In August 2014, in response to an impending massacre by ISIL at the besieged Sinjar Mountains, the U.S. intervened and launched airstrikes against ISIL in Iraq, allowing the YPG and Peshmerga to break the Siege of Sinjar Mountain and driving back ISIL forces. US airstrikes also drove ISIL back from the Iraqi Kurdistan capital of Erbil. In late September, President Barack Obama also authorized airstrikes against ISIL in Syria, as ISIL continued to consolidate their control in that country. In mid-September 2014, ISIL launched a massive campaign against Kobanî, besieging the city, and raising fears of another genocide. However, US airstrikes kept ISIL from being able to take the city and gradually thinned their numbers, while the Kurdish defenders and their allies continued to combat the attackers. In January 2015, ISIL finally retreated from the city, ending the siege, and by late March 2015, almost all of ISIL's gains had been reversed, and the terrorist group had lost thousands of fighters.

In late September 2014, it was revealed that ISIL planned to kill 10 million Americans.[23]

In December 2014, it was revealed that the US planned to retake the city of Mosul in January 2015, 7 months after the Fall of Mosul in June 2014. Also, from December 17–22, the Kurds launched a massive offensive, breaking the Siege of Mount Sinjar and effectively retaking most of the villages in the Sinjar region, as well as pushing into the city of Sinjar itself.

On January 21, 2015, the Kurdish Peshmerga launched an offensive into the outskirts of Mosul, retaking some nearby villages, cutting off of key supply route to Mosul, and opening up three fronts to the northwest of the city itself. Over 200 ISIL militants were killed on the first day of the Kurdish offensive. On February 4, 2015, Jordan joined the intervention in Iraq, launching a massive airstrike campaign in Mosul, in retaliation against ISIL's brutal killing of Jordanian pilot Muath al-Kasasbeh. The airstrikes killed 55 ISIL militants, including the chief ISIL senior commander in Mosul, who was known as the "Prince of Nineveh."

On February 1, 2015, Iraq's Prime Minister declared that the War on ISIL was effectively "World War III", due to ISIL's declaration of a Worldwide Caliphate, its aims to conquer the world, and its success in spreading the conflict to multiple countries outside of the Levant region.[24]

On February 4, 2015, Jordan began launching airstrikes on ISIL positions in Iraq, in retaliation for ISIL's brutal killing of Jordanian pilot Muath al-Kasasbeh. The airstrikes killed 55 ISIL militants in Mosul, including a senior ISIL commander known as the "Prince of Nineveh." On February 5, 2015, Jordan elevated its role in the US-led Coalition in Syria, launching one of the largest airstrike campaigns since early January 2015, targeting ISIL militants near Ar-Raqqah, the de facto ISIL capital, inflicting an unknown number of casualties and damaging ISIL facilities. This was done in retaliation against ISIL's brutal murder of Muath al-Kasasbeh.[25][26] On February 6, a continued round of Coalition airstrikes at Ar-Raqqah killed over 30 ISIL militants.[27]

On February 9, 2015, the Libyan town of Nofaliya fell to ISIL forces. Soon afterwards, the Libyan city of Sirte also fell, along with a military base to the south of Nofaliya and Sirte. After ISIL killed 21 Egyptian Coptic Christians in Libya,[28] Egypt began conducting airstrikes on ISIL targets in Libya on 16 February 2015, killing a total of 64 ISIL militants (50 in Derna) by the end of that day. Warplanes acting under orders from the "official" Libyan government also struck targets in Derna, reportedly in coordination with Egypt's airstrikes.[29] A Libyan official stated that more joint airstrikes would follow.[29] The airstrikes ended on February 18, with Egypt seeking more support from the US-led Coalition and the Arab World. The US and Italy also began conducting surveillance flights over Libya, due to concerns of further ISIL expansion.

On March 1, 2015, Iraqi Army forces and Shi'ite militias launched the Salahuddin offensive to liberate the Saladin Governorate from ISIL occupation. On the next day, 30,000 Iraqi Army soldiers, Sunni fighters, and Shi'ite militiamen launched the Second Battle of Tikrit (March–April 2015), to recapture the city of Tikrit, the provincial capital of Salahuddin that was being held by 13,000 ISIL militants. On April 17, 2015, the battle finally ended in a decisive anti-ISIL victory. In Syrian, in March, the YPG and their allies launched an offensive to clear ISIL from the northern Al-Hasakah province. While they managed to retake most of the ISIL-held areas around Tell Brak and Tell Hamis, ISIL launched another large-scale offensive into the Khabur River valley, capturing numerous villages and advancing to the western bank of the Khabur River. Violent clashes continued unabated into May, when the YPG and their allies finally launched a large-scale counteroffensive, retaking the areas lost to ISIL, the Abdulaziz Mountains, and the surrounding countryside. YPG-led forces then launched an offensive to take Tell Abyad from ISIL, advancing westward from the Al-Hasakah countryside and advancing eastward from their enclave around the Kobanî Canton. In June, both forces linked up and took Tell Abyad, before completely securing the M4 Highway and the neighboring regions in July, removing ISIL from the border region of the northern Ar-Raqqah couuntrysiide, and severing their most important supply route to Ar-Raqqah. In late June, ISIL launched an attack on the city of Al-Hasakah, in an attempt to capture it. However, after over a month of clashes and U.S. airstrikes, ISIL retreated, leaving most of the city under the control of the YPG, and the central parts of the city under the control of the Syrian Government.

On March 7, 2015, Boko Haram, a Nigeria-bases terrorist group, pledged allegiance to ISIL, giving ISIL an official presence in West Africa.

On March 19, 2015, the 4 concurrent insurgencies in Yemen (the al-Qaeda, Houthi, Southern Movement, and ISIL insurgencies) all merged into a single, full-blown conflict, the Yemeni Civil War. On March 25, 2015, after Houthi and Saleh loyalist forces pushed Hadi's Yemeni forces to the critical city of Aden, Saudi Arabia decided to lead the Gulf Cooperation Council and other Arab states in a military intervention against the Houthi forces. On April 1, 2015, the Southern Movement, whose territory was reduced to merely the Yemeni city of Ataq, decided to join forces with Hadi's internationally-recognized government, against the other warring factions. Ataq was captured by the Houthis on April 9. al-Qaeda in the Arabian Peninsula (AQAP) decided to take advantage of the chaos, launching an offensive in the northern part of Yemen and the southeastern coastal region, initially capturing the city of Al Mukalla on April 2, only to lose half of the city to local Yemeni tribes on April 7, with the battle continuing afterwards. However, al-Qaeda eventually managed to capture the city on April 16. However, al-Qaeda also lost most of the territory it held in Yemen's southwestern region. In late April 2016, UAE-backed forced launched an offensive into Al Mukalla and the coastal regions of the Hadramuat Province, recapturing the city and removing AQAP from most of their territory in Hadramuat.

On March 30, 2015, Ansar al-Sharia in Libya and its leader, Abdullah Al-Libi, pledged allegiance to ISIL,[30] boosting ISIL's membership in Libya to 8,000 fighters.[31][32]

On April 8, 2015, the Iraqi Army and 10,000 Sunni tribal fighters launched the Anbar offensive (2015) to retake the Anbar Governorate. In response, ISIL executed 300 people and launched its own counter-offensive in kind, resulting in fierce clashes around Ramadi. However, in May 2015, ISIL launched the Palmyra offensive, capturing the city of Palmyra and the majority of Central Syria, increasing their control of Syria to 50%.

In September 2015, the Russian Government intervened on behalf of the Syrian Government, after a string of losses to both the Syrian Rebels, al-Qaeda-lnked jihadists, and ISIL. In November 2015, Peshmerga fighters advanced down Mount Sinjar and recaptured the city of Sinjar and the nearby highway to the Syrian border, cutting off a key supply route for ISIL. In December, SDF fighters, backed by U.S. Special Forces, captured Tishrim Dam, one of the most important dams in Syria, opening a possible beachhead from which they could assault Manbij.

In 2016, the tide began to turn against ISIL. In Iraq, ISIL lost the city of Ramadi in February 2016, followed by Hit in April, Ar-Rutbah in May, and Fallujah in June. In Syria, ISIL lost Al-Shaddadi in February, Manbij and Jarabulus in August, al-Bab in February 2017, and Palmyra in March 2017 (for the second time). In Libya, GNA forces launched an attack on Sirte in May, recapturing the city and destroying the ISIL pocket in December. In October 2016, the Iraqi Army, backed by allied forces, launched a battle for Mosul, triggering the single largest military campaign since the 2003 Invasion of Iraq. In November, in northern Syria, the SDF, backed by the US, launched a campaign to capture Raqqa and its countryside from ISIL.

In 2017, the new Trump Administration loosened the rules for military engagements, leading to increased airstrikes on ISIL, which further reduced their numbers. In May 2017, ISIL forces in Marawi, in the Philippines, attempted to seize control of the city. After a 5-month-long battle, the ISIL forces were eradicated, resulting the the complete destruction of ISIL's leadership in the Philippines and the loss of the majority of their fighters. On July 22, 2017, after 9 months of grueling urban warfare, the Iraqi Army finally recaptured the city of Mosul. In Syria, ISIL lost control of the Syrian Desert and Central Syria to both the Free Syrian Army (before they were beaten back to a stretch of territory near Al-Tanf) and the Syrian Army. On October 19, in Syria, the SDF captured the city of Raqqa, which had served as ISIL's de-facto capital city up until that point. The Syrian Army also won a 3-month campaign against ISIL in Central Syria, removing ISIL control from Central Syria and capturing an area of land the size of Lebanon. In November, the Syrian Army broke ISIL's 3-year siege of the city of Deir ez-Zor and pushed into the ISIL-held half of the city, recapturing the city in December. The Syrian Army then launched further offensives southward, towards the Iraqi border, capturing the city of Mayadin. The SDF also launched a large-scale campaign in the countryside of Deir ez-Zor, in order to clear ISIL from the remainder of northeastern Syria. In Iraq, the Iraqi Army recaptured Tel Afar and Hawija from ISIL. In late October, the Iraqi Army launched an offensive into the desert regions in Western Iraq, to completely destroy ISIL's remaining control. On December 9, 2017, ISIL had lost control of their remaining territory in Western Iraq. By the end of 2017, ISIL had largely been reduced to 3 pockets of territory in Northeastern Syria, the Middle Euphrates River Valley, and in the Syrian Desert.

From 2018 to 2019, ISIL continued to lose territory. The Syrian Army besieged ISIL in the Syrian Desert and gradually reduced their large pocket, while the SDF cleared the ISIL pocket in northeastern Syria and applied more pressure to the ISIL pocket along the Euphrates River. ISIL leader Abu Bakr al-Baghdadi fled from the ISIL pocket in the Euphrates Valley to a safe house in the Idlib Province, which was mostly run by Tahrir al-Sham. In December 2018, the SDF finally broke through ISIL lines in the Euphrates Valley and took the city of Hajjin, before advancing southward. In February 2019, the SDF captured Al-Marashidah, leaving the remaining ISIL forces in the pocket completely besieged in the town of Al-Baghuz Fawqani. On February 9, the SDF launched an assault on ISIL's final stronghold, facing fierce ISIL resistance. However, as the SDF pushed deeper into the pocket, most of the ISIL members surrendered with their families. On March 23, the SDF captured Al-Baghuz Fawqani, before seizing full control of the region in April. This ended most of ISIL's territorial control and removed their final stronghold.

On the night of October 26–27, 2019, U.S. Special Forces raided al-Baghdadi's compound in Barisha, Syria, near the Turkish border. Al-Baghdadi killed himself and two of his children with his suicide vest when he was trapped in a tunnel, and most of the defenders were killed, while the US took some prisoners. In 2020, ISIL suffered even further losses, losing the majority of their territory in the Syrian Desert. This left ISIL as an insurgency. However, ISIL has been able to take advantage of security gaps in both Iraq and Syria, and the group is continuing to launch attacks in both Iraq and Syria on a regular basis.

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  21. ^ a b https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/pfizer-biontech-covid-19-vaccine
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  29. ^ a b "Libyan air force loyal to official government bombed targets in eastern city of Derna". Ynetnews. 16 February 2015. Retrieved 16 February 2015.
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  31. ^ "The Islamic State of Libya Isn't Much of a State". Foreign Policy Magazine. 17 February 2015. Retrieved 25 March 2015. He said that today there are about 1,000 to 3,000 fighters loyal to the Islamic State in Libya(subscription required)
  32. ^ Ansar al-Sharia in Libya joined ISIL in March 2015,[1] adding about 5,000 fighters to the group [2]


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