A version of this story appeared in the December 29 edition of CNN’s Coronavirus: Fact vs. Fiction newsletter. Sign up here to receive the need-to-know headlines every weekday.

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It is almost a year since China first reported cases of a novel coronavirus to the World Health Organization, on New Year’s Eve 2019. Since then, the virus has swept the globe, sickening more than 81 million people and killing at least 1.7 million. And while we have learned a remarkable amount about the disease, a number of questions remain unanswered as the year comes to a close, Julia Hollingsworth writes.

One thing became clearer on Monday: The scale of the crisis in the original epicenter of the pandemic may have been almost 10 times the official tally of confirmed cases. According to a study by the Chinese Center for Disease Control and Prevention, nearly half a million residents in the Chinese city of Wuhan may have been infected with Covid-19, Nectar Gan reports.

The study, which was conducted a month after China “contained the first wave of the Covid-19 epidemic,” found an antibody prevalence rate of 4.43% for Covid-19 among residents in Wuhan, a metropolis of 11 million people. As of Sunday, Wuhan had reported a total of 50,354 confirmed cases of the virus, according to the Wuhan Municipal Health Commission.

The study aimed to estimate the scale of past infections in a population by testing blood serum samples from a pool of people for coronavirus antibodies. Its findings are not taken to be final statistics of how many people in a given area have been exposed to the virus.

Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations, said the study points to a problem of underreporting in infections during the height of the outbreak in Wuhan, partly due to the chaos at the time, and a failure to include asymptomatic cases in the official count of confirmed cases. Underreporting is a problem faced by health authorities in many countries, often due to a lack of capacity and resources. Antibody studies conducted by researchers in other parts of the world also show the virus was much more prevalent than official numbers suggest.

But in China, there is also the question of transparency, as officials gave the public more optimistic data than they had access to internally, according to previous reporting by CNN. Authorities have cracked down on citizen journalists who reported on the harsh reality of overflowing hospitals in Wuhan. On Monday, Zhang Zhan, a former lawyer who documented the outbreak at its height in Wuhan, was sentenced to four years in jail for “picking quarrels and provoking trouble.” Two other independent journalists – Li Zehua and Fang Bin – were also detained following their coverage of the outbreak.

A former lawyer, Zhang Zhan traveled to Wuhan in early February to report on the pandemic and subsequent attempts to contain it. She was sentenced to four years in jail on Monday.

YOU ASKED. WE ANSWERED

Q: When will the pandemic be over?

A: Many people around the world are pinning their hopes on the vaccine, but even that isn’t a quick fix. It will likely take years to vaccinate the majority of the world’s population – something that would be necessary to stop the spread – and polls show that some people may not be willing to be vaccinated.

Even if they are, the vaccine isn’t a silver bullet. It’s likely that even when vaccination is widespread, we might still have to live with the virus. After all, only one virus in human history has been declared eradicated by a vaccine – smallpox.

Send your questions here. Are you a health care worker fighting Covid-19? Message us on WhatsApp about the challenges you’re facing: +1 347-322-0415.

WHAT’S IMPORTANT TODAY

Record US hospitalizations could force health experts to ration care

The US reported 121,235 patients hospitalized with coronavirus Monday, the highest that figure has been since the start of the pandemic. Intensive care Covid-19 patients have increased from 16% in September to 40% last week, and health experts anticipate holiday travel could mean a “surge on top of a surge.” At this rate, health experts warn they may have to ration nurses, respirators and care, Madeline Holcombe reports.

Amid the bad news, health experts say vaccinations need to be speeded up. So far, about 2.1 million vaccine doses have been administered in the US and more than 11.4 million doses have been distributed as of Monday, according to the US Centers for Disease Control and Prevention. Despite these developments, Dr. Ashish Jha, dean of Brown University’s School of Public Health, said Monday that the US is falling behind countries like Israel and Canada in the pace of its vaccination efforts. “We really do have to ramp this up,” he said. “Things are in a crisis.”

UK back in the ‘eye of the storm’ as cases surge

The United Kingdom recorded a record 41,385 coronavirus cases on Monday and 357 deaths. “We are back in the eye of the storm with a second wave of coronavirus sweeping Europe and, indeed, this country,” Simon Stevens, the chief of the National Health Service in England, said Monday.

In England, the tally of those hospitalized (20,246) is now higher than it was at the first peak of the pandemic in April (19,000). This is worse than the figure forecast by the British Medical Journal and the Health Service Journal earlier in December, when they warned the government should reverse its decision to relax Covid-19 restrictions over Christmas.

South Africa tightens restrictions as new variant is detected abroad

South Africa’s President Cyril Ramaphosa announced tougher restrictions on the country as new cases climb at an “unprecedented rate.” The announcement comes after a new Covid-19 variant was detected in South Africa and cases surged during the festive season. More than 50,000 new cases have been reported since Christmas Eve, and hospitals are close to capacity in a number of provinces, Ramaphosa said.

Under the tightened restrictions, all indoor and outdoor gatherings are banned for 14 days, the nationwide curfew will be extended, alcohol sales will be banned, and wearing a mask will become a legal requirement – with non-adherence leading to fines or up to six months in prison.

“We have let down our guard, and unfortunately we are now paying the price,” Ramaphosa said. Both the UK and South Africa announced separate variants of Covid-19 this month, prompting a number of countries to ban flights and restrict visas from both countries – the latest being South Korea.

ON OUR RADAR

  • Vice President-elect Kamala Harris is expected to receive her first dose of a Covid-19 vaccine live on camera from Washington, DC, on Tuesday. Her vaccination will come just over one week after President-elect Joe Biden received the shot.
  • British tourists fled the Swiss ski resort of Verbier “clandestinely” under the cover of darkness rather than submit to a new quarantine imposed on UK visitors.
  • The prolific Mexican composer and singer Armando Manzanero died Monday morning after battling Covid-19 for weeks.
  • Biotech company Novavax – which announced the launch of a Phase 3 trial of its Covid-19 vaccine in the US on Monday – confirmed it is also testing its shot against the UK strain of coronavirus that appears to transmit more easily.
  • When Covid first began spreading around the world, it seemed there was nowhere worse to be stuck than on board a cruise ship. From the unprecedented scramble for safe harbor to gigantic ghost ships, here’s how the world of cruising was turned on its head.

TOP TIP

Why picking your nose is dangerous in the time of coronavirus

Most of us pick our noses – some 91% according to the only (small and old) study that seems to have ever been done on the subject, perhaps revealing how little even scientists want to think about it.

Not only are you spreading your own bacteria and viruses onto everything you touch after a bout of digging for gold – but you also “transfer germs from your fingertips into the nose, which is the exact opposite of what you want,” said infectious disease specialist Dr. Paul Pottinger, a professor at the University of Washington School of Medicine in Seattle. That means that you can spread coronavirus to others from your nose-picking session, and you are also more likely to bring that virus, along with others like influenza or rhinovirus (the common cold), directly into your body.

TODAY’S PODCAST

“I can’t wait for the day when I no longer have to be on TV all day talking about the number of deaths due to Covid-19.” – CNN’s Chief Medical Correspondent Dr. Sanjay Gupta

What is the first thing you want to do when it is safe to see your friends and family again? In the last episode of the year, Dr. Gupta shares your biggest hopes and dreams for a brighter 2021. Listen Now.