1. What is COVID-19?
COVID-19 is a disease caused by the new coronavirus SARS-CoV-2, which is transmitted between humans and currently circulating in over 100 countries around the world. Currently, there are more than 19,913,062 cases and more than 732,128 deaths worldwide (see updated cases and deaths here). Over the last several days, there have been more cases occurring outside China than within the country.
In the United States, there are more than 5,055,355 cases and at least 163,077 deaths (see updated cases and deaths here) with 50 states, the District of Columbia and U.S. territories reporting cases. While most cases are travel-related or involve persons repatriated to the United States, an increasing number of these cases represent person-to-person spread, particularly in Washington state and California.
2. How does it spread?
The coronavirus spreads through droplets released most commonly from a sneeze or a cough and can also be spread through small aerosolized particles. Additionally, it may be transmitted by touching contaminated objects, like a table or door handle, and then touching your eyes, nose, or mouth. In general, exposure to individuals with significant symptoms in close-proximity (within 6 feet) over an extended period of time (15 minutes or greater) increases the chances of exposure to COVID-19. Pre-symptomatic spread is also thought to contribute to transmission, particularly in the 48 hours preceding the start of symptoms. There have also been reports of true asymptomatic spread of the virus and this is an active area of investigation by health officials.
3. What are the symptoms of COVID-19?
Common symptoms of COVID-19 include cough, fever, shortness of breath, fatigue, loss of smell or taste, and a headache. Health officials say that in more than 80% of cases, symptoms will be mild, and individuals will be able to self-manage at home as if they were treating a common cold or the flu. In the rest of the cases, symptoms may progress potentially resulting in worsening shortness of breath and cough and require medical intervention.
4. Who is at highest risk for severe complications?
Individuals who are elderly and who have chronic conditions, such as heart disease, lung disease, diabetes, and obesity are at highest risk for hospitalizations, severe complications and deaths. People with compromised immune systems, such as someone going through cancer treatments, are also at higher risk for infection if exposed.
5. What is the fatality rate?
The current fatality rate is roughly 5%. However, it is widely considered that the number of cases is significantly higher due to asymptomatic cases or mildly symptomatic individuals who never received a medical evaluation and testing. Thus, it is quite likely that the true fatality rate is significantly lower. Some experts believe that the true mortality rate associated with COVID-19 may be roughly 1% or less than 1%. For comparison, the case fatality rate for seasonal influenza is approximately 0.1%. When the pandemic began in March, the mortality rate was 3.4%.
6. What can I do to protect myself?
First, it’s important not to panic but arm yourself with facts about the disease so you can make smart decisions. It is critical that all Americans practice good hand hygiene, which includes washing hands frequently for 20 seconds with soap and water. If this is not possible, then using an alcohol-based hand sanitizer is a good idea. This is especially important before and after entering large group settings or coming home from the store. It is also recommended to refrain from touching your nose, mouth, or eyes as much as possible or use a tissue, and substitute handshakes for another greeting.
Social distancing—standing about a 6-foot radius from others—is another important measure to be taken based on your circumstances, especially around a sick person.
Evidence is showing wearing cloth-based masks in public settings, particularly indoors and outdoors, if social distancing is not possible, reduces transmission of the virus.
If you have symptoms of coronavirus—or any respiratory illness, for that matter—it is critical to isolate yourself as much as possible and reduce exposing others. You should discuss sick leave and telework policies with your employers so that you can reduce your and others’ risk of exposure.
It is also a good idea to have a 30- or 90-day supply of medications at home for you and your loved ones; individuals may need to contact their health care professionals, insurance companies or pharmacy benefit managers to make this happen.
7. Is there a test to detect the virus and a treatment or vaccine?
There are both tests that detect the virus as well tests that indicate past infection, though accuracy of the latter has been variable. Testing to detect the virus has increased across the country though experts believe we are still not testing enough, particularly in asymptomatic populations. Tests can be obtained either in health care settings, mobile testing sites, and soon through home mail delivery.
Two treatments have been shown thus far to provide benefit against COVID-19. Remdesivir, an antiviral medication, has been shown to reduce symptoms and the duration of illness in individuals with severe COVID-19. In addition, dexamethasone, a steroid, has been shown to reduce mortality in individuals on mechanical ventilation or receiving supplementary oxygen therapy.
Vaccine development is underway, and phase III trials will commence this summer for several vaccine candidates. These trials will involve thousands of individuals, young and old, to assess for potential adverse events and to demonstrate efficacy. Vaccine manufacturing will be started prior to study results being available so in the event that safety and efficacy are confirmed, distribution of the vaccine can occur promptly. Vaccine development is a complicated endeavor, and so even if all goes perfectly, we will likely not have a vaccine until some point in 2021.
8. Are certain populations being disproportionately impacted by COVID-19?
Yes, health inequities are driving a disproportionate number of cases in communities of color and underserved populations (precarious housing, lack of transportation options, frontline workers, lack of comprehensive paid leave) and health disparities are driving a disproportionate number of deaths in these same communities (due to lack of health insurance/usual source of care leading to the inability to prevent and manage chronic conditions which contribute to severe illness). In addition, outbreaks have centered around congregate living facilities such as long-term care facilities and prisons and jails as well as around certain employment sectors such as meatpacking facilities.
9. How will the U.S. suppress the virus?
There are three immediate tasks to suppress the virus. First, elected officials must follow the data and make evidence-based decisions with respect to reopening, pausing, and reinstituting community mitigation measures. Second, testing and contact tracing must expand to limit chains of transmission. Third, the American public will need to continue to adhere to physical distancing and the use of cloth-based masks in public to protect themselves and others.
10. Will there will be a second wave of the virus?
While we are still in the first wave of the coronavirus, there is significant concern that the fall and winter months could bring a second wave of the virus. This is not only because of colder weather leading to more Americans congregating indoors but also influenza season occurring simultaneously with COVID-19. The two together could overwhelm the health care system and thus efforts to stockpile personal protective equipment and critical medical material as well as develop additional therapeutics are essential.