COVID-19 (Coronavirus) Q&A

The following is a list of common questions and answers for people without medical training. If you have a question you would like added, feel free to write it in a comment below.

Questions:

1. What is the name of the infection?
2. How contagious is coronavirus? 
3. How is it transmitted?
4. Where did it come from?
5. Who can get infected?
6. Who is susceptible to complications?
7. Are pregnant women at risk?
8. What is an incubation period?
9. How severe is the infection?
10. Can you be infected and without symptoms?
11. What are the symptoms?
12. Can pets transmit COVID-19?
13. How far away do I need to be from someone who is infected?
14. What temperature is considered a fever?
15. How long does the virus survive on surfaces?
16. Is coronavirus sensitive to heat?
17. Is it true that warmer climates are less susceptible to coronavirus ?
18. Will the infection slow down when the summer arrives?
19. When I get symptoms, what should I do?
20. Do I need to get tested?
21. Can coronavirus be transmitted by food? If so, is it safe to eat food prepared outside the house?
22. Is it dangerous to use ibuprofen or anti-inflammatory medication when sick with COVID-19 ?
23. Is it true that influenza is worse than COVID-19, resulting in more deaths?
24. Is it true that coronavirus lives in the throat for 4 days before it reaches the lungs and that drinking a lot of water and gargling with warm water and salt or vinegar kills the virus ?
25. If I get sick, when can I come out of home isolation?
26. Is there evidence that omega-3 fatty acids are beneficial in preventing COVID-19 infection?
27. Is it safe to take elderberry supplements when sick with COVID-19?
28. Is it possible to avoid coronavirus (COVID-19)?

1. What is the name of the infection? 

The virus that causes the infection is officially named Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the World Health Organization. However, the disease that it causes is named Coronavirus disease 2019 (COVID-19).

Source: https://www.who.int/health-topics/coronavirus

2. How contagious is coronavirus? 

The intensity of an infectious disease outbreak is represented mathematically by a number called R-naught (R0). This number represents the number of people that can be infected by one person. For coronavirus, this number is a range from 1.2-3.3, with most quoting 2.2.  That means that a person with the infection can infect between 1-3 others. In comparison, the R-naught (R0) for the seasonal flu is 1.3.

Source: https://www.ebmedicine.net/topics/infectious-disease/COVID-19

3. How is it transmitted? 

It is believed to be transmitted by droplets from infected persons. These can travel up to 6 feet and are adequately filtered if the infected person wears a standard surgical mask (not a N95).  However, this is preliminary information. There is also evidence that it is transmitted by fomites (dust, surfaces). A person can become infected by touching a surface covered with fomites carrying the virus, and then touching their face. This is the reason that hand washing is so important.

Source: https://www.ebmedicine.net/topics/infectious-disease/COVID-19

4. Where did it come from? 

Like other coronaviruses, the origin is believed to be bats with an intermediate host being the pangolin. Transmission to humans is believed to have occurred in Wuhan China at a food market. 

Source: https://www.ebmedicine.net/topics/infectious-disease/COVID-19

5. Who can get infected? 

All ages are susceptible.

6. Who is susceptible to complications? 

The CDC notes that people with the following conditions are at increased risk of complications from infection. 

• Blood disorders (e.g., sickle cell disease or on blood thinners).
• Chronic kidney disease as defined by your doctor. Patient has been told to avoid or reduce the dose of medications because of kidney disease, or is under treatment for kidney disease, including receiving dialysis.
• Chronic liver disease as defined by your doctor. (e.g., cirrhosis, chronic hepatitis) Patient has been told to avoid or reduce the dose of medications because liver disease or is under treatment for liver disease. 
• Compromised immune system (immunosuppression) (e.g., seeing a doctor for cancer and treatment such as chemotherapy or radiation, received an organ or bone marrow transplant, taking high doses of corticosteroids or other immunosuppressant medications, HIV or AIDS) .
• Current or recent pregnancy in the last two weeks. _{*see next question*}
• Endocrine disorders (e.g., diabetes mellitus)
• Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
• Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
• Lung disease including asthma or chronic obstructive pulmonary disease (chronic bronchitis or emphysema) or other chronic conditions associated with impaired lung function or that require home oxygen
• Neurological and neurologic and neurodevelopment conditions [including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability, moderate to severe developmental delay, muscular dystrophy, or spinal cord injury]. 

Complications have been extremely rare in children and young healthy patients. The vast majority of COVID-19 complications have developed in patients over age 60. Death rate (mortality) in hospitalized patients with COVID-19 above age 80 has been reported as high as 21.9% in China. 

Source:

• https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf
• https://www.who.int/news-room/q-a-detail/q-a-coronaviruses 
• https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/  

7. Are pregnant women at risk?

The American College of Obstetrics and Gynecology has the following to say

“Currently available data on COVID-19 does not indicate that pregnant women are at increased risk. However, pregnant women are known to be at greater risk of severe morbidity and mortality from other respiratory infections such as influenza and SARS-CoV. As such, pregnant women should be considered an at-risk population for COVID-19. Adverse infant outcomes (eg, preterm birth) have been reported among infants born to mothers positive for COVID-19 during pregnancy. However, this information is based on limited data and it is not clear that these outcomes were related to maternal infection. Currently it is unclear if COVID-19 can cross through the transplacental route to the fetus. In limited recent case series of infants born to mothers infected with COVID-19 published in the peer-reviewed literature, none of the infants have tested positive for COVID-19.”

Source: https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-Novel-Coronavirus2019?IsMobileSet=false

8. What is an incubation period? 

An incubation period is the time during which the person is infected but has no symptoms. For COVID-19, the incubation period is thought to be 14 days, with most cases showing symptoms between 4-5 days after exposure. 

Source: 

• https://www.who.int/news-room/q-a-detail/q-a-coronaviruses,
• https://www.ebmedicine.net/topics/infectious-disease/COVID-19

9. How severe is the infection? 

Based on Chinese data: 

• 81% mild symptoms
• 14% sever symptoms: shortness of breath, low oxygen levels, pneumonia involving more than 50% of the lungs
• 5% critical disease: intubation, shock, multiorgan dysfunction.
• 2.3% mortality overall with all deaths in the “critical” patients only.

Source: https://www.ncbi.nlm.nih.gov/books/NBK554776/

10. Can you be infected and without symptoms? 

Yes. Screening exposed patients on a cruise ship found patients who tested positive but had no symptoms (50% of infected cases). It is unknown how many go on to become symptomatic. Another study by the CDC, of military personnel aboard a naval ship, found up to 20% of infected patients to be asymptomatic.

Source:

• https://www.ncbi.nlm.nih.gov/books/NBK554776/
• https://www.cdc.gov/mmwr/volumes/69/wr/mm6923e4.htm

11. What are the symptoms?

• Fever 99%
• Fatigue 70%
• Dry cough 59%
• Anorexia (poor appetite) 40%
• Myalgias (muscle aches) 35%
• Dyspnea (shortness of breath) 31%
• Sputum production (coughing up phlegm) 27%

Additionally, the CDC has added the following:

• Headache
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea

Source:

• https://jamanetwork.com/journals/jama/fullarticle/2761044
• https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

12. Can pets transmit COVID-19? 

There are cases of a pets (dog and cat) being infected but there are no known cases of transmission from pets to humans. The virus is transmitted from infected humans through droplets by coughing, sneezing, or speaking. Animal to human transmission is not thought to play a large role. More study is ongoing.

Source:

• https://www.who.int/news-room/q-a-detail/q-a-coronaviruses
• https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/animals.html

13. How far away do I need to be from someone who is infected? 

Droplet transmission is 3 feet (1 meter) for breathing, 6 feet (2 meters) for coughing, and up to 18 feet (6 meters) for an uncovered sneeze. Most recommendations recommend 3-6 feet of distance from an infected person.

Source:

• https://www.cdc.gov/infectioncontrol/guidelines/isolation/scientific-review.html
• https://pubmed.ncbi.nlm.nih.gov/17542834/
• https://www.who.int/news-room/q-a-detail/q-a-coronaviruses
• https://www.cdc.gov/nonpharmaceutical-interventions/pdf/244999C-6_Slow-the-Spread-of-Flu-Factsheet-final-508.pdf

14. What is considered a fever? 

In general, physicians use 100.4 F (38 C) as the starting point of fever. The CDC utilizes this definition of fever. However, the WHO recommends even if you have a low grade fever starting at 99.1 F (37.3 C) that you isolate at home. Fever is the most common symptom of COVID-19.

Source:

• https://www.cdc.gov/quarantine/maritime/definitions-signs-symptoms-conditions-ill-travelers.html
• https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

15. How long does the virus survive on surfaces? 

The virus can be detected for hours to days on a surface that has not been cleaned, depending on the material. One study has shown the virus lasts up to 72 on hard surfaces like stainless steel, less on others. However, the CDC notes this is not the primary method of transmission for the disease.

Source:

• https://www.medrxiv.org/content/10.1101/2020.03.09.20033217v2.full.pdf+html
• https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html

16. Is coronavirus sensitive to heat?

This is a common question in conversation as we talk about combating the virus. Since it can survive on surfaces, does heat kill the virus more quickly? Studies are in progress to see how long the current virus can survive in different temperatures. Meanwhile, we know from studies of previous coronaviruses, like the 2009 SARS outbreak, that low humidity and temperate climate (not very cold or very hot) allow the virus to survive longer on surfaces. This means our typical air-conditioned indoor climates are not helping things. One study found that high humidity and elevated temperatures killed the virus more quickly.

Source: https://aem.asm.org/content/76/9/2712.short

17. Is it true that warmer climates are less susceptible to coronavirus ?

It is unclear. There is some conjecture that tropical (warmer, more humid) climates may have less widespread infection than other cooler, dryer climates. However, the disease has not spread throughout the globe equally and testing is not equally performed throughout the world. So, it is too early to tell.

Source: https://www.medrxiv.org/content/10.1101/2020.03.12.20034728v1.full.pdf

18. Will the infection slow down when the summer arrives?

Possibly. The seasonal flu (influenza) has peaks that are worst in the fall and winter. Other coronaviruses have shown similar variance, but there is no data yet available to make the claim with this virus.

19. When I get symptoms, what should I do?

First, don’t panic. If you have a fever and you are able to control it with over the counter medication, stay home to prevent others from getting infected. If your symptoms are getting worse and you are becoming short-of-breath, call your doctor. If you are struggling to breath, go to the nearest emergency department. Be sure to notify them of your fever as soon as you arrive in order to protect other patients and staff.

20. Do I need to get tested?

It is important to remember that testing does nothing to treat the infection. There are studies in progress, but there is no approved treatment yet. A positive test result may give you an answer to the question “do I have COVID-19?”, but it does nothing to treat it. Testing kits are in short supply, as are the swabs necessary to perform the test. Tests are prioritized for patients requiring hospitalization. In these patients, a positive test result changes requirements for isolation and has relevance to procedures for treatment. For those who do not require hospitalization, testing is not necessary.

21. Can coronavirus be transmitted by food? If so, is it safe to eat food prepared outside the house?

The US Food and Drug Administration notes “Foodborne exposure to this virus is not known to be a route of transmission.” Also, the World Health Organization notes that although it is possible with other viruses (influenza, SARS 2009) this mode of transmission is considered “rare”. The FDA has detailed instructions on procedures for restaurants to follow when employees become infected. So, the answer is that this kind of transmission is rare and not the primary way it is spread. When deciding when to eat outside of your home, selecting a restaurant that you trust is best. Many restaurants have been open about changes they are making during the epidemic in the US.

Source:

• https://www.fda.gov/food/food-safety-during-emergencies/food-safety-and-coronavirus-disease-2019-covid-19
• https://www.who.int/foodsafety/publications/micro/Viruses_in_food_MRA.pdf

22. Is it dangerous to use ibuprofen or anti-inflammatory medication when sick with COVID-19 ?

Short answer, NO. There was quite a lot of reaction to comments from the French Health minister claiming that ibuprofen may put you at risk. There was also an article published in the Lancet journal where some theories were shared regarding medications that might make someone more susceptible to coronavirus. However, all these theories are yet to be proven. There is currently NO evidence that ibuprofen causes harm when taken while infected with coronavirus. Until these theories are proven true, the WHO and the FDA recommend starting with acetaminophen (Tylenol) for pain or fever. Additionally, both organizations note that you do not need to stop ibuprofen if you are using it for another medical condition.

Sources:

• https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30116-8/fulltext
• https://www.fda.gov/drugs/drug-safety-and-availability/fda-advises-patients-use-non-steroidal-anti-inflammatory-drugs-nsaids-covid-19
• https://twitter.com/WHO/status/1240409217997189128/photo/1

23. Is it true that influenza is worse than COVID-19, resulting in more deaths?

This is a deceiving question meant to confuse the reader. As of today, March 25, 2020 the seasonal flu which began in 2019 and is ending now has resulted in an estimated 54 million infections in the US and between 23,000-59,000 deaths. In the 4 months since it began in China (less in the US) coronavirus is causing far more critical illnesses and deaths. Do not allow this question to confuse a year of influenza statistics with only 4 months of COVID-19 statistics. Italy’s experience alone is an obvious example of coronavirus being far worse than the seasonal flu.

Sources:

• https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm
• https://coronavirus.jhu.edu/map.html

24. Is it true that coronavirus lives in the throat for 4 days before it reaches the lungs and that drinking a lot of water and gargling with warm water and salt or vinegar kills the virus ?

No. This is a common myth circulating on social media. Gargling may help with the symptoms of a sore throat, however it does not kill the virus. Drinking water is important, but it does not “wash” the virus into the stomach where “stomach acid kills” the virus. Other common myths can be found on the Johns Hopkins website below.

Source: https://www.jhsph.edu/covid-19/coronavirus-facts-vs-myths.html

25. If I get sick, when can I come out of home isolation?

The CDC has provided two ways to decide when isolation can be stopped for anyone with COVID-19. Choose one:

1. Three days have passed since fever stopped, without use of medicine AND cough or shortness of breath is gone. PLUS ten days have passed since symptoms started.
2. Resolution of fever, without use of medicine AND improvement in cough or shortness of breath. PLUS two negative swabs for coronavirus at least 24 hours apart.

Notes: The second strategy is limited by test availability. Also, if you work in healthcare, these strategies do not apply. The CDC has separate guidelines for releasing healthcare workers from isolation.

Source: https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html

26. Is there evidence that omega-3 fatty acids are beneficial in preventing COVID-19 infection?

Omega-3 fatty acids are an important part of the membrane that surrounds human cells. There are numerous benefits from taking these supplements and the National Institute of Health has a great fact sheet listing all of them (see source below). Unfortunately there is no evidence that these are beneficial specifically in coronavirus or other viral infections. That does not mean it is not true, just that it is an unproven theory. However, you do still benefit from taking them in normal doses for other medical conditions. Do not take more than instructed.

Source: https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/#h1

27. Is it safe to take elderberry supplements when sick with COVID-19?

There has been significant discussion in the medical community about the “cytokine storm” that has been seen in the sickest of patients, on ventilators, who develop failure of multiple organs. This has been seen COVID-19 patients, but also reported with other viral infections. Elderberry has been shown to be helpful in patients infected with influenza, however, it has also been shown to increase the body’s release of cytokines. Because of this increase, some have recommended that elderberry be avoided in people with COVID-19 symptoms or positive COVID-19 tests. Though there is no evidence that elderberry places anyone at increased risk, this recommendation is made “out of an abundance of caution” until further evidence is available.

Sources:

• https://www.ncbi.nlm.nih.gov/pubmed/11399518
• https://www.ncbi.nlm.nih.gov/pubmed/15080016
• https://www.ncbi.nlm.nih.gov/pubmed/12455180
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4711683/
• https://parenting.nytimes.com/childrens-health/elderberry-benefits-dangers

28. Is it possible to avoid coronavirus (COVID-19)?

Possibly. For more details on social distancing, testing, vaccines and a way forward, please see the longer answer here.