By Elissa Rosen, MD, CEDS-S
Coronavirus Disease 2019
You probably already feel overloaded with information on the 2019 coronavirus disease, but the medical team at the Gaudiani Clinic wants to make sure that our patients, providers, and general community have the latest, most up-to-date, and most accurate information about the coronavirus. Today, we are going to go through general information about what is known right now about this coronavirus, but please know that this information may change quite rapidly as we learn more about the virus so stay tuned to our social media feed and website for updates.
Basic terminology
First, you have probably heard this coronavirus called by different names and seen different abbreviations to describe it. The actual virus itself is being referred to as severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2. The disease that it causes is now being referred to as the coronavirus disease 2019 or COVID-19. Previously, you may have seen the disease referred to as 2019 novel coronavirus or 2019-noCoV, but COVID-19 has now taken over as the preferred abbreviation.
What is a coronavirus?
Coronaviruses are common in both humans and animals and generally cause respiratory illnesses. In fact, coronaviruses are a frequent cause of the common cold in humans. Over the last 20 years, however, there has been an emergence of new strains of coronaviruses that originated in animals and then spread to humans. These include the original SARS-CoV (spread from bats to civets to humans) and MERS-CoV (spread from bats to camels to humans). The current strain of coronavirus first originated in Wuhan, China at a live animal market. The virus originated in animals (the question of which ones is still being investigated), but now is being spread from person to person.
How does the virus spread?
At this time, transmission of the virus from person to person is believed to be primarily through respiratory droplets and not airborne transmission. With airborne viruses, such as measles, smaller droplets can remain suspended in the air for hours. As you can imagine, airborne viruses are highly contagious. The primary means of transmission of this virus is through viral filled respiratory droplets contacting mucous membranes such as the eyes, nose, and/or mouth. For example, someone with the virus coughs or sneezes and those droplets land on that individuals’ mucous membranes. The radius of spread of droplets is about 6 feet so you would need to be in fairly close proximity of someone with an active infection to potentially contract the illness yourself. It is also possible that the virus can be spread by touching surfaces that have viral droplets and then touching your eyes, nose, or mouth, but at this time the CDC does not believe this is the primary means of viral transmission. With other coronaviruses, viral droplets can last on a surface for days, but it is unknown at this time how long the current virus might last on a surface.
How contagious is this virus?
Scientists use a term called the basic reproduction number or R0 (pronounced R-nought) to determine how easily a virus spreads. R0 is essentially the average number of people that catch a virus from a single infected person. Influenza, for example, has an R0 of 1.3 meaning for every 1 person with influenza they will spread it to 1.3 people. For measles this number is 18 again indicating that it is a very contagious virus. The best estimate right now for this coronavirus is that the R0 ranges between 2-3. This number, of course, will also be impacted by factors such as how often people come in contact with each other and efforts to reduce viral spread.
What are the symptoms of COVID-19?
COVID-19 causes a lower respiratory infection. Symptoms can range from mild such as fever and cough to severe such as the development of pneumonia with complete respiratory failure. General symptoms include fever (temperature greater than 100.4 F), cough, and shortness of breath. These again may progress in severe cases to respiratory failure requiring supplemental oxygen or mechanical ventilation (a breathing machine). There is also some evidence that people infected with coronavirus may be completely asymptomatic. How much this occurs and how this plays a role in the spread of COVID-19 is yet to be determined. The Chinese Center for Disease control reports that of the more than 44,000 cases of confirmed COVID-19 from the end of December 2019 to mid-February 2020, 80.9% of the cases were considered mild while 13.8% of the cases were severe and 4.7% were critical. It appears that children are less likely to be affected by coronavirus while those over the age of 60, those with weakened immune systems, or those with underlying lung disease or other serious pre-existing medical conditions are the most susceptible.
The death rate from a typical influenza season is 0.1%. At this time, the death rate from COVID-19 is estimated between 2-3.5% though of course these numbers are not fully known and may actually be higher in reality given discrepancies in access to testing and identifying those with COVID-19.
Helpful chart of influezna v. known COVID-19 symptoms
How long does it take for symptoms to develop?
In someone exposed to COVID-19 it is believed that symptoms will generally develop within 2 to 14 days of initial exposure.
Who is at risk for COVID-19?
At this time, those at risk for COVID-19 include someone who has traveled to an area with widespread or ongoing community spread of the virus and/or has been in close contact with someone with known COVID-19. International areas with ongoing and sustained viral transmission include China, Iran, Italy, South Korea, and Japan. The CDC advises avoiding all non-essential travel to these countries at this time. Risk for COVID-19 in the US is changing on a daily basis. For the most up-to-date information on cases in the US, please visit the CDC’s COVID-19 website at https://www.cdc.gov/coronavirus/2019-ncov/index.html.
At this time, the risk of getting influenza in the US remains higher than the risk of COVID-19. The CDC reports there have been 32 million cases of influenza in the US this season so far with 310,000 hospitalizations and 18,000 deaths from the flu. Compare this to cases of COVID-19 in the US which are estimated in the hundreds right now.
Is there a test for COVID-19 and who should be tested?
Yes, there is a test to identify COVID-19. Testing involves obtaining swabs from your nose and mouth and, if possible, from any sputum in those with a productive cough. Results from the swab can take 24-48 hours.
What should I do if I think I have COVID-19?
If you are sick, stay at home unless you need medical care. If you suspect you may have COVID-19, call ahead to your doctor’s office to inform them of your symptoms. They can then determine with guidance from your local health department the next steps to take regarding whether to see your provider, if you need testing, and where/how to get this done. If you need immediate medical attention then, of course, seek emergency care or call 911. Notify the 911 operator of your concerns for COVID-19 so they can be prepared. If you do need to leave home for medical care, wear a mask (most health care facilities have them available this time of year due to influenza) on or before entry into the health care facility. If you live with someone else, try to isolate yourself as much as possible when at home. Use a separate bathroom if possible and be sure to clean all “high touch” surfaces with household cleaners or wipes (see next section for more advice on how to minimize transmission).
In terms of when to return to work or leave the house, if you truly have COVID-19 your healthcare provider can direct you. Generally, it is safe to leave the house once your risk of viral transmission is low which is generally when you no longer have symptoms such as cough and fever.
What can I do to protect myself from COVID-19?
Here are the best things you can do to minimize your risk of COVID-19 or other respiratory viruses like influenza:
- Avoid close contact with people who are sick.
- Stay at home if you are sick (unless you need medical attention).
- Wash your hands often. Use soap and water and wash for at least 20 seconds. If soap and water are not available, use alcohol-based hand sanitizer with at least 60% alcohol. Cover all surfaces of your hands with the sanitizer and allow it to dry fully.
- Avoid touching your nose, mouth, or eyes with unwashed hands.
- Clean “high touch” surfaces using household cleaners or wipes.
- Cover a cough or sneeze with a tissue (or your elbow) then dispose of the tissue in the trash.
- The CDC does not recommend wearing a mask if you are not sick. Wearing a mask may increase someone’s sense of safety from infection and, thus, decrease behaviors such as handwashing, etc. In addition, wearing a mask may be associated with more facial touching.
- Get a flu shot if you have not gotten one! Risk for flu at this moment remains higher than COVID-19.
Is there a treatment or a vaccine for COVID-19?
There are no current treatments for COVID-19. Antiviral medications that have been used in HIV and Ebola are being tested as possible options, but there are no specific medication treatments at this time. Supportive care is the main means of treatment. For those with more severe forms of the illness this may involve hospitalization and use of supplemental oxygen or mechanical ventilation if someone can no longer breathe on their own. At this time there is no vaccine for COVID-19. Scientists are working on creating one, but it will likely be 12 to 18 months before a vaccine is available.
Where can I get accurate, up-to-date information about COVID-19?
For up-to-date information on all things coronavirus, please visit the CDC coronavirus website and check back with our website and social media feed for updates as they come: https://www.cdc.gov/coronavirus/2019-ncov/index.html
13 March 2020 Update:
https://www.colorado.gov/pacific/cdphe/news/lab-implement-changes-drive-cdphe-drive-covid-19-testing-site-lowry-tested-more-650-coloradans
12 March 2020 Update:
CO Health Department expanded criteria for testing: https://www.colorado.gov/pacific/cdphe/covid-19-testing
Current recommendations from CO Health Department for those who may have been exposed to COVID-19 and are asymptomatic: https://docs.google.com/document/d/e/2PACX-1vSXHB102mQo3LRv_4RqcRmC-somCLS4q0KpI1qHo0MhCCfGPVVDiL6VyjDhykPmXuT4nNsneuhXwCsm/pub