A Novel Coronavirus: What You Need to Know About COVID-19
As a new coronavirus causes widespread illness around the world, many people are wondering how to protect themselves and their loved ones. Here's what we know about COVID-19 thus far -- with a reminder that this is an emerging situation, and new information about the 2019 coronavirus and its impact is coming out every day.
What is COVID-19?
Coronavirus disease 2019 (COVID-19) is a respiratory disease caused by a new strain of coronavirus. Coronaviruses are a large family of viruses, only a few of which can infect humans.
Until now, six coronaviruses have been known to cause disease in people: SARS-CoV-1 and MERS cause severe disease, while HKu1, NL63, OC43, and 229E typically cause mild symptoms (including about one-third of cases of the common cold).
The new (“novel”) coronavirus, which scientists have named 2019-nCoV or SARS-CoV-2, is causing both mild and severe illness. However, the proportion of people who are becoming extremely sick after infection with the virus is very high. The percentages vary from country to country and depend largely on health systems and resource. So far, however, in countries with advanced health systems, about 20 percent of people with COVID-19 have required hospitalization; about 5% intensive care (including mechanical breathing machines), and about 2.4% have died.
Scientists are not sure why the illness is so devastating for some people, while others can be infected and have no symptoms (i.e. be asymptomatic). They do know that people 60 and older and those with other health conditions, especially heart and lung disease, seem to be most susceptible. However, that does not mean that younger people will not get very sick and possibly die from the disease. In the United States, according to the CDC, about 40% of people hospitalized with COVID-19 were between the ages of 20 and 44 years, and of those, 0.1% died (about the same as overall flu deaths, including older populations). The death rate in older people is much higher, reachining 20% or higher in those 85 years and older.
What are the signs and symptoms of COVID-19?
COVID-19 is an infection of both the lower and respiratory tract, which seems to be partly why it passes so easily between people. Scientists are still learning about the signs and symptoms of COVID-19 and how the disease affects different people. They do know that COVID-19 tends to affect the lungs and chest; only some people seem to experience a runny nose or sinus congestion.
Symptoms that people have experienced include:
- Fever 88%
- Dry cough 68%
- Fatigue: 38%
- Coughing up thick secretions (sputum or phlegm): 33%
- Difficulty breathing/shortness of breath: 19%
- Bone or joint pain: 15%
- Sore throat: 14%
- Headache: 14%
- Chills: 11%
- Nausea and/or vomiting: 5%
- Stuffy nose: 5%
- Diarrhea: 4%
- Coughing up blood: 1%
- Swollen eyes: 1%
Need to Know: One important new clue emerged in mid-March: British researchers reported that many people with COVID-19 lose their sense of taste (called anosmia) and smell (called ageusia). With this new clue, doctors and public health officials ask anyone who suddenly loses their sense of taste and/or smell to self-isolate for seven days, even if they are not experiencing any other symptoms.
Is it Cold, Flu, or COVID-19?
Signs and symptoms of COVID-19 can mimic flu, cold, or seasonal allergies. Here is a quick chart that can help you to tell the difference.
|Fever||Rare; mild if present||Common||No||Common|
|Stuffy or Runny Nose||Common||Occasional||Common||Infrequent|
|Cough||Mild||Dry cough||Mild||Dry cough, often severe|
|Shortness of Breath||No||Rare||No (except in anaphylaxis)||With mild/ moderate infection|
|Difficulty breathing||No||In severe infections.*||No (except in anapylaxis)||Common in severe infections*|
*Needs emergency care, including oxygen and/or ventilation
How does COVID-19 spread?
COVID-19 spreads easily from person to person. People are thought to be most contagious when they are showing the most symptoms, such as cough and fever. However, it also appears that people can be infected for several days without feeling sick and spread the disease without knowing it.
While researchers are still working to find out exactly how 2019CoV spreads, they have identified three main routes:
Route 1: Droplets. If an infected person coughs and sends a spray of tiny droplet particles into the air, enough of the virus is carried along to infect someone sitting nearby. When you open your mouth to take a breath, droplets can land in your mouth or nose, or you can inhale them into your lungs. In addition, virus-containing droplets settle on nearby surfaces – like the lunch you may be eating while sitting next to a friend who may be infected – and can infect you via Route 2.
Route 2: Contaminated surfaces or objects. Studies show that the virus can live for 24 hours or more on cardboard, and up to 5 days on stainless steel and some plastics. When an infected person rubs their nose then touches the door-handle at the grocery store, she leaves a large dose of virus on that metal surface. When you come along behind her and grab that handle, you are exposed to a wallop of virus. Itch your nose, and you’ve inoculated yourself.
Route 3: Feces. 2019CoV has been found in the feces of some patients diagnosed with COVID-19. Researchers aren’t sure how much virus is shed in stool, for how long, and whether someone can become infected by coming in contact with it. The U.S. Centers for Disease Control and Prevention (CDC), the risk of infection via feces is low. There had been no reports of fecal-oral transmission as of March 10, 2020. However, a study of 15 patients at the University of Nebraska Medical Center found a significant amount of virus on the toilet seats of 81% of patients, suggesting that enough virus is shed in feces to pose a danger of infection.
Route 4: Is it airborne? Researchers are still investigating the possibility that SARS-CoV-2 is routinely transmitted via the air. In airborne transmission, unlike droplet spread, the virus stays in the air for a significant time, so people who are close enough or enter the room may be exposed. Measles is one example of a contagious disease that spreads this way. The University of Nebraska team found that even without coughing, people who are even mildly ill with COVID-19 may release enough virus into the air to infect another person. They found significant viral particles in the hallways just outside patients' rooms, which they suggested might have come from health-care personnel leaving the room. Still, that doesn't mean the virus is airborne -- just that droplets could stay in the air for a significant amount of time.
Where did 2019CoV come from?
Evidence suggests that 2019-nCoV jumped from bats to humans in an open seafood market in the city of Wujahn, China. In February, a group of researchers from China examined the gene sequences in virus samples taken from from nine patients who were among the early cases. They found that almost no genetic differences between the viruses in the nine people, which suggests the virus very recently emerged in humans and was detected relatively rapidly. By sequencing the genome of the virus, they were able to discover that 2019-nCoV is most closely related to other coronaviruses found in bats. They concluded that 2019-nCoV appears to have crossed from bats to humans, although another animal species may have acted as an intermediate host.
This and other research contradicts harmful myths that has been circulating on social media and several websites. It confirms that the 2019CoV was not manufactured in a laboratory. While the emergence of this virus caught the world unprepared, it was not unexpected by those who study viral behavior.
How Can I Avoid Getting Sick?
What’s the most important thing you can do to stop the spread of COVID-19? Don’t get infected. Health care systems – even the most advanced – are not built to accommodate millions of sick people all at once. That’s why it’s so important to “flatten the curve” by staying away from situations where you might be exposed to 2019CoV.
Need to Know: Many people use the terms social distancing, isolation, and quarantine interchangeably. They are not the same. Here are some brief definitions of the terms and when the practices are used:
- Social distancing is the practice of healthy people staying away from others (at least 6 feet) to avoid getting sick
- Isolation is when people who know they are sick stay away from other people
- Quarantine is when someone who has been exposed to a disease but is still healthy cuts off all contact with others for a certain period of time, during which they either develop the disease or remain disease-free.
In practice, what does social distancing really mean? Here are the steps you can take to protect yourself and your family:
Stay home. Stay home from work, shopping malls, church, and other places where people gather. Don't stop in to visit friends, and don’t have people over.
- Shop once a week for groceries and other essentials, and minimize the number of stores you go to. Stock up on essentials, in case you need to be home for 14 days. But don’t hoard. Other people need toilet paper, too.
- If you are 60 or older, don’t shop for yourself. Use a grocery delivery service if one is available in your area, ask a younger friend to shop for you, or work with your community leaders to develop a delivery network for you and other seniors in your area. The delivery person should leave your groceries outside. Use sanitizing wipes to clean all surfaces before touching the groceries.
- Cancel all travel plans. Really, truly. Even if you are young and in excellent health, do you really want to get sick while traveling? And do you want to take a chance of infecting your family when you get home?
- Work from home. If you can’t work from home, call your state hotline and ask about temporary unemployment benefits or other ways they can support you while you are not working. Even freelance and other gig workers may find some support, depending on their state.
- Keep kids home. Keeping kids home from school is one of the most effective ways to slow the spread of disease. Use technologies such as videoconferencing to keep learning going – including private lessons.
Wash your hands. Wash your hands whenever you come into the house, before and after you use the toilet, prepare food, eat, change a diaper, touch pets, handle trash, etc. Your hands are constantly touching potentially contaminated surfaces. Washing them frequently can reduce your risk of getting COVID-19 -- and many other infectious diseases.
- How to wash your hands with soap and water. Give yourself 20 seconds -- try counting slowly to 20 or singing a song while wash. Wash the fronts, backs, sides, fingers, thumb, and between your fingers, and under your nails, with plenty of soap (it doesn’t need to be antibacterial soap) and warm water. Wash all the way up to your wrists. After you’ve washed and rinsed the suds down the drain with plenty of warm water, dry your hands with a paper towel, turn off the faucet with a second paper towel, and throw the towels away. Use a trash can with a lid.
- How to cleanse your hands using an alcohol-based hand sanitizer. Water and soap are always best, but in a pinch, you can use an alcohol-based hand sanitizer that contains at least 60% alcohol. You can make your own with 40% aloe vera gel, 60% rubbing alcohol, and a drop or two of essential oil. Use about a quarter-sized dollop, and rub briskly, getting all the nooks and crannies. Don't forget the backs of your hands and thumbs.
Cover your coughs and sneezes. No matter what the reason for a cough or sniffles, cover your cough. When you cough or blow your nose, grab a tissue and cover your mouth and nose. Throw out the tissue and wash your hands immediately. Teach everyone in your family to do the same. Some experts recommend coughing into the bend of your elbow, which is undoubtedly better than your bare hand, but then your clothing could be contaminated.
Disinfect frequently touched items. Use a solution of 4 teaspoons of unexpired bleach per quart of water. Make sure the bleach is fresh, hasn’t passed the expiration date, and has been open for one month or less. Here are some items to disinfect:
- Light switches
- Cell phones
- Remote controls
- Computer mice
- Pens and pencils
- Refrigerator doors
Take off your shoes. Shoes carry stuff – from dog-poop to 2019CoV. Think of all the places you step when you are walking around outside, even in your own yard. Take them off before you walk around your house or apartment.
Don’t touch. If you do go out of the house for essential items, minimize the number of things you touch, including handrails, doorknobs, fences, and more.
Don’t touch your face. It’s hard. Harder than you think. But you can train yourself not to touch your face.
Close the toilet lid before you flush and use the bathroom vent fan. When you flush the toilet with the lid open, something called a “toilet plume” is released. The plume can hover for hours within one meter of the toilet. So you’ve effectively sprayed your entire bathroom with about 80,000 droplets containing bacteria, viruses, and whatever else can be found in feces. If your toothbrush is sitting on the counter, it receives a direct hit. Simply closing the lid can reduce (but not eliminate) the number of droplets significantly; turning on the bathroom fan can help the plume to dissipate more quickly. Researchers from Hong-Kong recommend this step specifically for preventing infection from 2019CoV; more evidence is accumulating that it's a really, really good idea.
How to Take Care of Someone Who Has COVID-2019
If you find yourself caring for someone who’s sick, remember that you have two goals:
- Help them get better
- Don’t get sick yourself
1. Helping Someone Get Better.
There is no treatment for COVID-19 – only what doctors call “supportive care.” That means rest, plenty of fluids, nutrition, and medications for comfort (generally acetaminophen/paracetamol or ibuprofen for fever, aches and pains). Use a humidifier to moisten the airways, and let the person sleep and rest. If the person is well enough, some movement might help to clear junk out of the airways. In care facilities for people with mild illness in China, people were invited to partake in gentle dancing, and it seemed to help.
The US Food and Drug Administration (FDA) has not approved any drugs specifically for the treatment of patients with COVID-19. Several drugs are being investigated, and at least have shown some promise in treating COVID-19. But there’s not enough evidence for any recommendations to be made. Never take a prescription medication without a doctor’s order. The results could be deadly.
Thus far, about 80% of people who have developed COVID-19 have had “mild” disease – which includes everything from feeling mildly ill to something like an unimaginably bad flu. These people can be cared for without special medical interventions. Supportive care, including plenty of rest, fluids, and over-the-counter medicines such as ibuprofen or acetaminophen, has been enough for these people .
But 1 out of every 5 people who have been diagnosed with COVID-19 have needed more care than can be given at home. Older adults and people who have chronic medical conditions, especially conditions that affect the heart and lungs, seem to be at greater risk for more serious complications, including death. But everyone, even those in younger age groups, is at risk.
Call 9-1-1 or take the person to the hospital (or other local facility) if any of the following emergency warning signs are present. Be sure to tell the dispatcher that the person has or may have COVID-19:
- Shortness of breath
- Bluish lips or face
- Difficulty talking
- Persistent pain or pressure in the chest
- The person becomes confused or you can’t wake them up
At the hospital, the person will receive supplementary oxygen and, if necessary, mechanical ventilatory support. Once people are ventilated, they may need to be on the machine for up to 30 days.
2. Don't get infected yourself.
Most spread has been in families. If you are caring for someone with COVID-19, take steps to protect yourself. The person who is sick should stay in a separate room and use a separate bathroom if one is available. Use an N-95 mask, properly fitted, if you have one, gloves, and other protective gear whenever you are in the room with the person who is sick. Disinfect surfaces, laundry, and other items that the person has touched or breathed on. For more about caring for someone with COVID-19 at home, see the CDC guidelines for home care.
How long will the COVID-19 outbreak last?
While no one knows exactly what to expect, most epidemiologists and virologists predict that the current outbreak will last in the range of 18 months. That's about how long they expect it to take to develop a vaccine to the virus and for people to.
The most important tool for controlling the pandemic, however, is testing. Only with widespread testing will health officials be able to identify most people who are infected with 2019CoV2, where they live, and stamp out the embers of the epidemic.