I’ve been getting a lot of questions about Covid-19 (Coronavirus disease 2019). Here is what you need to know.
Note that this article was completed on March 7, 2020. This overview is based on the current understanding of Covid-19 and advice from multiple pages on the CDC and WHO websites dedicated to Covid-19, published research (as well as this paper and this editorial), and New York State Department of Health. Given that our knowledge regarding Covid-19 is evolving rapidly, for up to date information, please refer to the WHO, CDC website, your local health authority, and your qualified healthcare provider, for most current information. This is not medical advice.
How severe is the illness from Coronavirus?
The complete clinical picture resulting from SARS-CoV-2, which is responsible for Covid-19 (coronavirus disease 2019), is not yet fully understood and is a topic of active investigation.
We know that symptoms can range from mild to severe, and the illness can result in death. While information so far suggests that most Covid-19 illness is mild, a report from China published in New England Journal of Medicine suggests that serious illness occurred in 16% of confirmed cases.
Who are the high-risk populations for Covid-19?
Older people and people with certain underlying health conditions are at greatest risk of serious illness. Immune systems change with age, making it harder for the body to fight infections. Furthermore, individuals with chronic conditions such as chronic lung disease (e.g., COPD), heart disease, and diabetes, are considered to be at higher risk.
What should individuals with higher risk for severe illness do?
High risk individuals tend to experience a more severe form of Covid-19. They should talk to their doctor about what symptoms to monitor for and what to do. They should also avoid crowds and any potential exposures to individuals who may be infected. They should practice good hand hygiene (more on this below) and avoid going anywhere where they could be exposed. They should ensure they have enough supplies, including medications, on hand. CDC has excellent resources for actions that higher risk individuals should take.
How does coronavirus spread?
The outbreak of coronavirus, SARS-CoV-2, responsible for Covid-19 (coronavirus disease 2019), started in Wuhan, Hubei Province, China. SARS-CoV-2 originated from bats. The outbreak was linked to a seafood and live animal market, suggesting that it started with animal-to-person spread. As the virus continued to spread, new patients did not have exposure to animal markets, which indicated that it continued to spread person-to-person.
Person-to-person spread can occur in one of several ways. For example, this can occur when people are close to each other (less than 6 feet) or through respiratory droplets that travel when an infected person coughs or sneezes. The droplets can land on the mouth or nose of a newly infected person or may be inhaled into the lungs. It can also occur if an infected person shakes hands with an uninfected person or touches the same surface that an uninfected person subsequently touches.
According to the CDC, Covid-19 seems to be spreading easily and sustainably in the community in affected areas, as shown here.
There is also evidence, published in JAMA, that there is viral shedding from the stool.
Can I get the virus from a person who is infected but not showing any symptoms?
It is thought that people are most contagious when they are symptomatic. It is possible that people may spread this virus before they show symptoms, but this is not thought to be the main mechanism by which the virus spreads.
What about touching surfaces – can I get it from touching a doorknob?
Touching a surface contaminated with the virus, then touching your nose, mouth, or possibly the eyes could be a way to get Covid-19, however this is not thought to be the main mode of transmission.
What is the incubation time of coronavirus?
Scientists have estimated that while the incubation time can range from 2 to 14 days, most symptoms emerge in 4-7 days.
What are the symptoms associated with coronavirus?
Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed coronavirus disease 2019 (Covid-19) cases.
Symptoms may include:
- Difficulty breathing
- Diagnosis of pneumonia (which typically presents with the symptoms above)
What do we know about infected individuals and severity of disease of patients in China?
In this study, data were collected from 1099 patients with laboratory-confirmed Covid-19 from hospitals in mainland China. The median age of the patients was 47 years and almost 42% of the patients were female. Almost half of the people had fever on admission to the hospital, and almost 90% had fever during hospitalization. Over 2/3 of patients had a cough. Diarrhea was uncommon, only at 3.8%. Median incubation period was 4 days. 5% of the patients required admission to the ICU, 2.3% of the patients required mechanical ventilation and 1.4% died.
Patients with severe disease were older than those who did not have severe disease by a median of 7 years. Furthermore, those with severe disease were more likely to have coexisting conditions (such as COPD, high blood pressure, heart disease and diabetes).
What is the mortality rate of coronavirus in the world today?
According to WHO, on March 7th, there are currently 80,813 cases in China and 3073 deaths (implying a mortality rate of: 3.8%, assuming that these numbers are accurate). Outside of China, there are currently 21,110 confirmed cases and 413 deaths (implying a mortality rate of: 1.96%, assuming that these numbers are accurate). It should be mentioned, however, that there are likely asymptomatic and minimally symptomatic individuals who are not included in the total cases. Anthony Fauci, MD, (director of the National Institute of Allergy and Infectious Diseases) and colleagues wrote an editorial in New England Journal of Medicine that argues that if we assume that the number of individuals who are asymptomatic or minimally symptomatic is “several times as high as the number of reported cases, the case fatality may be considerably less than 1%.” In this case, the consequences of Covid-19 may be more comparable to “a severe seasonal influenza (which has a case fatality of approximately 0.1%).”
As diagnostic tests become available to more people and as we become better at
detecting Covid-19, we will likely get a better estimate of the mortality associated with it.
As diagnostic tests become available to more people and as we become better at detecting Covid-19, we will likely get a better estimate of the mortality associated with it.
How to do I protect myself and others during coronavirus threat?
- Wash your hands thoroughly multiple times throughout the day. This is especially important if you are touching doorknobs or touching other surfaces that other people touch. Wash your hands by scrubbing for at least 20 seconds (to time yourself, you can sing or hum Happy Birthday or Twinkle Twinkle Little Star). Here is more from CDC on how and when to wash your hands.
- Avoid contact with people who are sick whenever possible. If you are in contact with anyone who is sick, use appropriate precautions.
- Avoid touching your face; especially your mouth, nose, and eyes, and particularly after having touched other surfaces.
Clean frequently touched surfaces and objects (e.g., door knobs). Dr. Jay Butler, CDC’s Deputy Director for Infectious Diseases and Senior Response Official for the Covid-19 response, states that although this is still being researched, survival of the virus on a surface could range from minutes to hours.
- If you are sick, stay at home.
- Avoid non-essential travel and large events.
- Avoid shaking hands.
- If you sneeze or cough, do so into your elbow.
- Use your own pen to push elevator buttons, sign receipts or press the cashier monitor when paying with your credit card.
- Stay up to date by checking the CDC, WHO and your local health authority website, as well as calling your qualified healthcare professional.
Is wearing a mask going to help me?
Although wearing an N95 respirator does have a role in the medical setting, CDC does not recommended the use of respirators outside of the workplace settings. CDC also doesn’t recommend the use of a facemask for coronavirus prevention. Because facemasks fit loosely and oftentimes people adjust them or might even reach under the mask to touch their mouth or nose, their use is not advised by the CDC. They also don’t filter out small particles effectively and don’t prevent leakage around the edges of the mask when a person inhales.
When should I call my doctor?
Call your doctor if:
- You develop symptoms (as described above) and have been in close contact with a person who has Covid-19.
- You have recently returned from an area with widespread or ongoing community spread of COVID-19.
Should I avoid traveling?
This depends on several factors. CDC recommends avoiding non-essential travel to Level 3 travel health notice countries. CDC recommends special precautions to high risk travelers to Level 2 travel health notice country (Japan). Hong Kong is currently on Level 1 travel health notice and travelers can learn more about precautions about traveling to Hong Kong here.
The CDC currently advises travelers to Level 3 countries to:
- Avoid contact with individuals who are sick and to wash their hands often (wash with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer with 60%–95% alcohol).
- Upon return home, travelers should stay home for 14 days after returning to the United States and practice social distancing.
- Travelers who are sick with fever, cough, or have trouble breathing should call their doctor before seeking medical care.
Keep checking the CDC website for up-to-date information on which countries to avoid travel to or any extra precautions that you should take.
Many conferences and large group meetings, as well as non-essential work and pleasure travel are being canceled, given the growing number of cases.
What about going to work and work meetings?
Employers are now advising employees to work from home if they note any signs of illness, as well as to opt for web meetings or phone calls rather than in person meetings in order to reduce the risk of exposure and transmission of virus. Keep up to date with your employer’s recommendations.
How does coronavirus compare to the flu?
Keep in mind that each flu season is a potential for influenza to become pandemic. The number of cases of the flu in the State of New York by the end of February 2020 was the highest in the last 20 years (since the 1998-1999 flu season)! The flu is responsible for more than half a million deaths around the world every year, so it is important to keep this in mind as well and take the right precautions (and the flu vaccine).
What is the state of coronavirus in New York?
Governor Andrew M. Cuomo declared a state of emergency today, March 7th, to help New York contain the spread of coronavirus more quickly and effectively. There are currently 76 cases in the State of New York, with 57 of these in Westchester county. To read more and get the most up to date information, go to the New York State Department of Health website.
Is a vaccine against coronavirus going to be developed?
According to Dr. Jay Butler, CDC’s Deputy Director for Infectious Diseases and Senior Response Official for the Covid-19 response, even if a vaccine can enter a clinical trial in the coming months, it’s unlikely that a vaccine will be available to the general population in the next 18 months.
We do have a vaccine available against the flu, however. He urges people to get the flu vaccine if they haven’t already. The vaccine is approximately 50% effective this season, and this is especially important given the number of cases this year.
What about people who have documented Covid-19 infection?
Dr. Butler stated that people who have had documented Covid-19 infection should be isolating at a healthcare facility or at home until they’ve had 2 negative specimens (from both nasal and throat swabs) at least 24 hours apart. Refer to the CDC website for most up to date information and discuss this with your qualified healthcare provider.
I have read and understood everything. As always, your advice and articles are very eloquent and useful.
Thank you Anna. I’m glad this is helpful.
I love your newsletters and wish you were still here in Beverly Hills! You are a wonderful doctor and your patients in New York are so lucky!
I’m glad to hear you are enjoying my newsletters! Thank you for your kind words. I offer telemedicine to California patients:)
Thank you for the update, there is so much information flying around and so much crazy panic it’s a relief to have such sensible advice and information.
I hope you and your family stay safe and well.
Thank you Sue. Stay well!