COVID-19: What we know so far about the 2019 novel coronavirus
A contagious respiratory disease that was first detected in China in December 2019 has spread worldwide. The 2019 novel (new) coronavirus has been named SARS-CoV-2 and the disease it causes is called coronavirus disease 2019, or COVID-19.
Although health officials here and abroad are working to track and contain the growing epidemic, the Centers for Disease Control and Prevention (CDC) expects widespread transmission of COVID-19 in our country. As an infectious disease specialist and hospital epidemiologist at the University of Chicago Medicine, my job is to prepare for outbreaks such as COVID-19 while caring for patients at our academic medical center on Chicago’s South Side. The extent of this outbreak is rapidly evolving and risk assessment changes daily, but here’s what we know about COVID-19 as of today:
What is a coronavirus? What is a novel coronavirus?
A coronavirus is the name for a large set of illnesses, including the common cold and other respiratory infections. The term “novel” coronavirus means it’s a new form of the virus.
Where and how did COVID-19 begin?
We learned about this particular virus shortly after a cluster of severe pneumonia cases were reported on New Year’s Eve 2019 in Wuhan, which is in the Hubei Province of China.
How does the COVID-19 spread?
This virus is really transmissible and can spread easily from person to person even before a person develops symptoms. It’s carried on respiratory droplets when we talk, sneeze, and cough and these can land on surfaces or in someone’s mouth or nose. When it comes to respiratory droplets, 6 feet is the magic distance. That’s how far these tiny, infected droplets can travel. Being within 6 feet of someone who is sick can get you or your personal space contaminated with COVID-19.
When droplets land on surfaces, we can pick them up with our hands and transfer them to our eyes, mouth, and nose when we touch our faces. This is why hand hygiene is so important. Good hand hygiene means washing our hands not just after we're using the restroom or before we're eating but regularly throughout the day. Respiratory secretions (like snot and sputum) are also be infectious, so cover your coughs and sneezes, use disposable tissues, throw them away when you're done, and wash your hands afterward. Keep your work surfaces clean and wipe off your keyboard and your phone.
What are the symptoms of COVID-19? Is it deadly?
It typically causes flu-like symptoms. Some patients — particularly the elderly and others with other chronic health conditions — develop a severe form of pneumonia.Patients develop symptoms like fever, muscle and body aches, cough, and sore throat about 5-6 days after infection. Most people will feel pretty miserable for a week and get better on their own. Some people won’t get as sick, but it’s still important not to be out and about, so as not to spread the disease. A minority of patients will get worse instead of better. This usually happens after 5-7 days of illness and these patients will have more shortness of breath and worsening cough. If this happens, it’s time to contact your doctor again or even go to an emergency room. Be sure to call first so they know you are coming.
The numbers of people who have been diagnosed and how many have died are changing daily. As of early March, there have been over 125,000 confirmed cases, with a death toll of about 4,500 (more than 3,000 in mainland China). But these numbers are just estimates; it’s still unclear how many people have actually been infected worldwide. Most of the deaths have been in adults over 60 years old who had other health concerns.
For those who suffer from allergies or chronic sinus problems in general, how do we best identify the differences between seasonal symptoms and COVID-19?
A stuffy and runny nose aren’t common symptoms of the new coronavirus. If you're mostly having those symptoms, then you probably have something else.
But if you are having contact with people who are at higher risk for bad outcomes, or if you’re immunocompromised, then I would strongly recommend talking to your own physician about how you can best control your allergy symptoms through this difficult spring season.
It may be worthwhile to take a daily antihistamine so your allergy symptoms are kept at bay. Then you can better tell the difference between allergies and a bad infection with COVID-19.
Is everyone at risk for catching COVID-19?
Yes. It doesn’t appear anyone is naturally immune to this particular virus, and there’s no reason to believe anybody has antibodies that would normally protect them. However, children appear to be among those least likely to have a bad outcome from contracting the disease.
The lack of previous experience with this virus is part of the reason public health officials are working so hard to contain the spread of this particular coronavirus. When viruses are both new (which means the population is highly susceptible) and can easily pass from person to person (a high transmission rate), they can be very dangerous.
Why do some people with the COVID-19 get sicker than others?
It looks like only about 20% of people who contract this novel coronavirus need to be hospitalized. The other 80% get what feels like a bad cold and recover at home. A lot of this has to do with underlying medical conditions. People who are more vulnerable to any kind of infection — because of their age or chronic health conditions — are more at risk for getting really sick from COVID-19.
That said, some otherwise healthy people do seem to be getting sicker from this infection than we would expect. We don’t understand why that is or what might be different about these patients. If you have COVID-19 and you are getting sicker and sicker instead of better and better, you should contact your doctor or visit an ER. Be sure to call first so they know to expect you.
Who are the most at-risk for contracting a severe case of COVID-19?
The most vulnerable populations for having a bad outcome with COVID-19 – including needing to be in the hospital or on a ventilator – are people over the age of 60 (especially men) with additional medical concerns. This includes people who are smokers, who have hypertension (high blood pressure) and diabetes, people who have low immune systems, people with underlying lung disease or who take medicines to suppress their immune systems because they have some sort of autoimmune condition or cancer.
We strongly recommend that these individuals begin curtailing all of their outdoor activities in accordance with the recent CDC guidelines. These people should not be traveling, and they should not be out in crowds. They should be staying home as much as possible. And if you haven't been instructed to work from home, you should ask about working from home if you are in one of these groups.
Does the pneumonia vaccine provide any protection against COVID-19?
There is no antibiotic (they are designed for bacterial infections, not viral ones) to treat COVID-19. Scientists are already working on a vaccine, but we don’t expect to have a good vaccine until spring of 2021 at the earliest. However, ongoing trials in China suggest that there are some existing antiviral drugs that may be helpful for the sickest patients. In fact, the University of Chicago is part of a multi-institutional team that has mapped a protein of SARS-CoV-2 and found drugs previously in development for SARS could be effective for COVID-19.
For now, doctors can only treat the symptoms, not the virus itself.
Similarly, the pneumonia vaccine protects against a type of bacterial pneumonia, not the COVID-19 virus. However, it’s still important to get the pneumonia vaccine – particularly if you’re over 65 or have a compromised immune system. It can keep you safe from other illnesses that are circulating or shorten the severity of your sickness if you contract bacterial pneumonia.
What kind of medical care do patients with COVID-19 need?
It’s the 20% of COVID-19 patients who get really, really sick that worry many of us in the infectious diseases field. A lot of these critically ill patients wind up needing to be hospitalized for their pneumonia-like illnesses. They typically require critical care and ventilation — special machines that help them breathe. And some need to stay on ventilators for weeks at a time. It’s this portion of patients that is most concerning. Depending on how many cases develop here in the U.S., providing that level of care for so many people over a number of weeks runs the risk of overwhelming the nation’s health care system pretty quickly. We can help prevent this kind of “surge” in patients by practicing social distancing (see below for more explanation).
How do you screen patients for COVID-19?
At Chicago Medicine, our teams are following guidelines from the U.S. Centers for Disease Control and Prevention. That means we’re asking any patient who has respiratory symptoms and a fever if they’ve traveled to the affected areas in the past two weeks or been in close contact with someone who has COVID-19.
Patients who answer yes will immediately be given a facemask and put in an isolation room, which has special airflow designed to keep airborne germs from getting out into other rooms. Then, they’ll be tested for the usual seasonal respiratory viruses and, if those are negative, tests will be sent for COVID-19 as well. Turnaround time on the COVID lab test is 1-2 days. People will need to remain in isolation until they’re cleared. But they may not need to stay in the hospital. Most patients are well enough to rest at home while waiting for the test results.
We’re also instructing our clinical teams to follow standard infection control protocols. Our doctors, nurses and other clinical staff will wear protective gear, such as gowns, gloves, masks and eye shields. That’s what they do with anyone who has something like the flu and it’s the same steps we followed during the SARS and MERS outbreaks. We’re also reminding everyone to make sure to wash their hands regularly and avoid touching their faces — that’s good practice any time of the year, and especially during flu season.
Should people be more concerned about the seasonal flu or COVID-19?
There’s widespread seasonal flu activity going on right now all around the U.S. But there are steps you can take to protect yourself from influenza. You can get an annual flu shot. You can take medication like Tamiflu that protects you from getting influenza after you’ve been exposed. You can cover your mouth and wash your hands to mitigate the spread. And, like clockwork, this year’s influenza strain is going to die out in the spring because it will have run its course.
The challenge with COVID-19 is that we probably can’t contain it and we don’t know if we’re really prepared as a country for a massive coronavirus epidemic. If we are lucky, it will slow down a bit over the summer but the next few months look like they are going to be pretty tough for all of us. We need to be as ready as we can for whatever comes our way and know that we will get through it eventually.
How can I protect myself? Should I wear a facemask?
Take the preventive actions you do for the cold and flu. This includes avoiding close contact with people who are sick; not touching your eyes, nose and mouth; washing your hands thoroughly and frequently; and cleaning and disinfecting objects and surfaces you come in contact with regularly.
The CDC does not recommend you wear a facemask to protect yourself from getting COVID-19 or other respiratory illnesses. While it feels like it should be protective to have something physically blocking your face, for otherwise healthy people, it doesn't work as well as we'd like to think it does. Air and germs can get around the sides of the mask.
Masks are also very important in keeping our healthcare workers safe. We have a nationwide shortage of masks, both the regular kind and the N-95 special masks, that healthcare providers are wearing when we're caring for COVID-19 patients. We need to do our best, both out in the community and even in the hospital setting, to ensure we are being good stewards of that resource so the masks are available when we need them.
I'm immunocompromised, but I still have to go to work. Is there anything I can do to protect myself?
A lot of people still have to work, including healthcare workers. Social distancing is still important, and there are things you can do to help social distance while at work. For example, you can join meetings through teleconferencing instead of going to the meeting room. You can also do things by phone when you would have done them in-person, even if you need to be on site.
If you work in a place that has shared workspaces, try to spread those workspaces out. People who can work from home can work from home, and then you can move into their spaces so that there's more distance between everybody who needs to be in the office.
Another option for shift workers could be shortening and rotating shifts so that half the people are working a shorter shift in the morning and the other half work a shorter shift in the afternoon, resulting in fewer people in every shared space. There’s a lot of creative options you can come up with to reduce the number of human beings that are within 6 feet of you.
The other thing that really matters is to clean off your surfaces regularly. We know from some studies out of Singapore that even when you have sick people around, if you clean surfaces regularly, it really does help to decrease spread of germs. Make a plan with your coworkers to wipe down all the doorknobs, shared surfaces, and any shared workspaces that you might have. Clean them off every hour and then wash your hands.
Will the flu shot protect people from COVID-19?
Unfortunately, the flu shot is not effective against this virus. But it will help protect you from the flu, and the flu is still what you’re more likely to catch right now.
Can I get tested for COVID-19 if I’m worried I’ve been exposed?
Only if you are sick. The test to diagnose COVID-19 isn’t useful unless you are sick and it’s still more limited than any of us want it to be. Make sure you tell your doctor about any risks for COVID you may have so they can get you a test if you need it.
It’s also worth mentioning that people shouldn’t be worried if they go to their doctor’s office and get tested for respiratory viruses and the results say they have a coronavirus. That’s because coronavirus is the name for a whole group of viruses, including things like the common cold. Most doctors’ offices can test for normal, everyday coronaviruses. If you see test results that say you have one, you shouldn’t worry. If you are being tested for COVID-19, your doctor will be very, very specific and will walk you through any results that come back.
Is COVID-19 airborne?
In infection control, we draw a line between things that are transmitted by traveling in the air briefly in respiratory droplets and things that are actually aerosolized and float around for a while. Think of droplets as small bits of fluid that you can feel and see when someone sneezes. You sneeze or cough and these droplets get on surfaces and then you touch them and get them on your hands, or they can fly right into your mouth or nose or eyes. That’s how most coronaviruses are transmitted and that’s how we think this one is too.
Aerosols are different. Think of hairspray after you use it in the bathroom. When you go back to the bathroom later, you may still be able to smell it because it’s lingering in the air. Obviously, we’re learning a lot about this virus, but most coronaviruses aren’t airborne that way. Generally speaking, there may be times when some of these droplets or particles are airborne, but it’s limited.
Are seemingly healthy people “shedding” the virus to others?
Yes, but we don't have a great sense of how many asymptomatic people are walking around infected with COVID-19 because we aren't testing those people. This will eventually become more evident, though, and will influence, and likely lower, the information we’re seeing about the death rate from the coronavirus. We don't know who might be potentially contagious, which is another important part of why people should stay away from other individuals.
What if someone I live with becomes sick with COVID-19?
If you are living with someone who has tested positive for COVID-19 and is being quarantined, you need to stay separate from that person as much as possible. Additionally, be very careful about maintaining good hand washing and cleaning of high-touch surfaces like doorknobs and countertops. When you do need to be in the same room as the individual, wear a mask.
What does quarantine mean for COVID-19? When should I consider quarantining myself?
We use the word quarantine in a really specific setting. Normally, your physician or the public health department is going to be the ones recommending the practice of quarantine. If you or a family member gets sick with COVID-19, you could find yourself in a mandatory 14-day (or longer) quarantine, and you won’t be allowed to leave your home, even to run errands. You would stay in the same place for the entire duration of the quarantine period.
How should I be talking to my children about COVID-19?
With all of the event cancelations and school closures, it’s important we discuss what is happening with school-aged children who will likely be disappointed or scared by what they are hearing. The most important thing to let your children know is that they are going to be fine throughout this, and there are a lot of grownups working hard to help keep everybody safe. At the same time, we need our kids to also help keep others, including their parents and their grandparents, safe. We need their help with social distancing, washing their hands and covering their coughs.
Will this virus die off in spring or summer when the temperatures warm up?
We don’t know specifically how COVID-19 will react to higher temperatures. However, at a minimum, warmer weather can help us better cope with social distancing. Being out in wide open spaces is a safer way to be in the world and interact with other people, and it can make it easier on those who have kids at home.
Source: https://www.uchicagomedicine.org/forefront/prevention-and-screening-articles/wuhan-coronavirus
- 20-Mar-2020
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