National Center for Health Research, Updated November 2, 2020
The coronavirus can infect anyone, young or old, healthy or frail. Here’s what you need to know.
People who are over 60 or who have cancer and other serious health conditions, and their loved ones, need to be especially careful. The CDC has recently updated which health problems put people at greatest risk, and they include many common health conditions: Anyone who is obese (BMI of 30 or higher) or has a serious heart condition, Type 2 diabetes, a weakened immune system (from cancer or an organ transplant), chronic kidney disease, COPD, or sickle cell disease is especially at risk if they are exposed to the coronavirus. Smoking also increases the risk of being seriously harmed by the virus, as do many other medical conditions, including asthma, high blood pressure, pregnancy, HIV, and liver disease.
If you had scheduled medical appointments, surgery, screening, or other procedures in the spring that were considered not urgent or not immediately life-threatening, those were probably postponed. This was for everyone’s protection. Many of those procedures were rescheduled for the summer or autumn, but may have been postponed again as Covid-19 cases surged in October. Many hospital staff, including doctors, nurses, receptionists, and cleaning staff, have been exposed to the virus and don’t know whether they can infect others. You don’t want to be exposed to the coronavirus when you go in for surgery or testing procedures for other medical conditions. And, you don’t want your medical center to be less able to fight the coronavirus at a time when it is spreading throughout your community.
The coronavirus is still spreading in all 50 states, in urban, suburban, and rural areas, so it is important to listen to health experts who tell you to stay home, limit contact with others, wear a mask, and keep a distance of 6 feet away when you or your family members or caregivers go grocery shopping or other essential activities. Unfortunately, some governors, mayors, and state legislators have reopened businesses for political reasons, even in states where the virus is spiking. Even if you are staying at home as much as possible, the fact that others in your community are going to bars, parties, restaurants, stores, and hair salons will put you at greater risk when you make essential visits to the supermarket, to work, to the doctor, or spend time outdoors, because you may come into contact with people who are infected because they aren’t being as careful as you are.
What is coronavirus?
Coronaviruses are a large group of viruses that can cause respiratory illness. The new (novel) coronavirus is called SARS-CoV-2 and the illness it causes is called coronavirus disease 2019, which is why it’s abbreviated as COVID-19. Since it is new, nobody has immunity from it.
How does COVID-19 spread between people?
The virus usually spreads through close contact with other people, especially through invisible or very tiny droplets when a person coughs, sneezes, sings, exercises – or even when they breathe or talk normally. These droplets can travel through the air and can be inhaled or get into the noses, mouths, or eyes of people nearby.
The virus is thought to be most contagious in the days just before and just after a person develops symptoms, but it is possible to catch the virus from infected people who have no symptoms at all. Experts still don’t know how contagious the virus is when a person has it but never develops symptoms. This is crucial information that scientists are trying to find out, especially since experts believe that many young children never develop symptoms, while other children get very sick and some have died from the coronavirus.
What about children? Unlike the flu, which is riskiest for the youngest children and oldest adults, infants and young children are much less likely to get sick from the coronavirus than adults. Preliminary studies suggest that children over 10 are as contagious as adults, but that younger children are much less infectious. For example, there are few known examples of the virus spreading in daycare centers that follow coronavirus safety standards. Nevertheless, almost half a million children have been diagnosed with the virus in the U.S. (almost 10% of all cases) and 70,000 children were newly diagnosed in late August, which was 17% more than the weekly number of new cases two weeks earlier. Fortunately, few children become so sick that they are hospitalized (estimates range from less than 1% to 8.5%), and less than half of 1% of children diagnosed with coronavirus in the U.S. have died.
The tiny droplets from coughing, sneezing, singing, talking, or breathing (as well as fecal matter containing the virus) can result in the virus on surfaces where it can survive for hours or even days. When you touch these surfaces and then touch your face, you can be exposed to the virus. That’s why it’s important to wash your hands regularly. If you don’t have antiseptic wipes, you can wipe down surfaces in your bathroom, kitchen, and other rooms with bleach or rubbing alcohol to help prevent exposure.
What about food or food packaging? The risk of catching the virus from packaging is very low, but since the virus can survive for up to 24 hours on cardboard and up to 3 days on plastic and stainless steel, it’s a good idea to wash your hands for at least 20 seconds after handling mail, takeout containers, and packaging from groceries. You can also disinfect food packages using a cleaning product that kills viruses, but DO NOT use bleach or other disinfectants on fruit, vegetables, or any other food.
What are the symptoms of COVID-19?
Symptoms tend to start between 2 and 14 days after coming into contact with the virus. Although some people have compared the symptoms to a cold or flu, not everyone with COVID-19 has those types of symptoms. In fact, some people (especially children, teens, and younger adults) have very mild symptoms or none at all, which is why getting tested is so important before you spend time with others. The CDC says that people with these symptoms or combination of symptoms may have COVID-19:
- Shortness of breath or difficulty breathing
Or at least two of these symptoms:
- Repeated shaking with chills
- Muscle pain
- Sore throat
- New loss of taste or smell
- Congestion or runny nose
- Nausea or vomiting
Those are the most common symptoms. However, children or adults can have other symptoms as well, including heart problems and “covid toes” that look like a minor case of frostbite.
Most people who are infected with this coronavirus have mild symptoms and can recover at home in about 2 weeks. However, symptoms can become severe. These are the ones that require immediate medical attention:
- difficulty breathing or shortness of breath
- persistent chest pain or pressure
- confusion or inability to awaken
- blueish color in the lips or face
As described above, people who are older than 60 or with other medical conditions are more likely to develop severe illness and complications from COVID-19. The most serious complications include pneumonia, stroke, blood clots, organ failure, and death.
How can I protect myself and others?
The best way for anyone to protect themselves is to avoid being exposed to the virus. There are no proven cures or vaccines, so don’t be fooled by claims regardless of the source. Two types of medications have been found to help people who are seriously ill, but are not a cure. Remdesivir has been found to help very ill patients by reducing the number of days of hospitalization in one study, but was not effective in a WHO study published in October. It has not been proven to save lives. Two inexpensive steroids, dexamethasone and hydrocortisone, have been found to reduce the chances of dying among COVID-19 patients on ventilators or those requiring oxygen, but not other patients. Regeneron, the experimental antibody drug that President Trump took when he was diagnosed, has been found to have a potential safety concern and as of October 30 is no longer being administered experimentally to hospitalized patients receiving mechanical ventilation of intense oxygen. However, it is still being studied on less seriously ill COVID-19 patients.
Despite the hopes of the White House, experts now agree that hydroxychloroquine with or without azithromycin is not a good treatment for COVID-19 because it has been found to increase heart problems and has not been shown to prevent or treat COVID-19. Another possible treatment is blood plasma from people who recovered from COVID-19. Research has shown these transfusions are usually safe, but there is no clear evidence that they are beneficial.
Research is continuing to find out which of these treatments are safe and effective and for which patients.
“Social distancing” or “physical distancing” refers to staying away from other people because it is impossible to know who has the virus. The safest people in your life are the ones you are living with who are not exposed to others who might have the virus (in other words, they are not going to work or spending time close to other people). Staying at home and not seeing your friends and loved ones is not fun, but it is essential for your own safety and for everyone else’s. If everyone does that now, the spread of this virus will be reduced sooner, and some of these restrictions will no longer be necessary in a few weeks.
Spending time with friends, family, or people at work
- Avoid spending time with others if you or any of them have symptoms of COVID-19 or have been exposed to someone with COVID-19 in the last 14 days.
- Anyone who has had close contact with a person with COVID-19 should stay home and monitor for symptoms.
In general, the more people you interact with, the more closely you interact with them, and the longer that interaction, the greater your chances of becoming infected or infecting others. So, think about:
- How many people will you interact with? (The fewer the better)
- Can you keep 6 feet of space between you and others?
- Will you be outdoors or indoors? (Outdoors is somewhat safer)
- What’s the length of time that you will be interacting with people? (Shorter is better)
Research conclusively shows that face masks or cloth that covers your mouth and nose help to prevent the spread of the coronavirus. Some masks are more effective than others: stretchy “gators” may actually do more harm than good, and bandanas and scarves are too loose to be very helpful. The paper masks worn in hospitals are effective and so are cloth masks you can make for yourself or buy, if they are made of cotton and at least two layers thick. Masks are important to prevent people from spreading the virus and also to help helps prevent infection or serious symptoms for the person wearing the masks.
The benefit of masks is clear when we look at a map of where COVID-19 cases are located in the U.S. and where people are most likely to wear masks. States with green lines have high rates of mask usage (90-99% of people wearing masks) and states with dotted lines or no lines at all have the lowest rates of wearing masks (less than 80% or less than 70%, respectively). As we can see from the map, in states where people are less likely to wear masks, there are more COVID-19 cases. In New York, for example, where 92% of people wear masks, only 14% of people reported knowing someone with COVID-19 symptoms. On the other hand, South Dakota, which has the lowest rate of mask usage in the U.S. (65%), had the highest percentage of people –45%– who knew someone with COVID-19.
Data as of Oct. 19
Source: Delphi CovidCast, Carnegie Mellon University and The Washington Post
Bottom line: Since most of us can’t get coronavirus tests every day, it’s especially important to wear masks whenever you are out in public or with people you don’t live with. But you should NOT be out in public or with people you don’t live with except when it’s essential. Depending on your age, health, and who you spend time with, it may not be safe for you to go to all the places that are open. Especially avoid indoor areas where you are likely to be close to others for more than a very short period of time (15 minutes) or whose workers are close to many other people, such as a tattoo parlor, hair or nail salon, restaurant, concert, party or movie theater. If you must go to a store, try to go to one that makes appointments with customers or limits the number of customers, and spend less than one hour indoors to reduce exposure to any coronavirus that is in the air.
- stay at home or go outside in your yard or neighborhood where you can keep at least 6 feet away from others
- avoid public spaces where there are other people, especially indoors
- avoid public transportation when possible and unnecessary travel
- avoid all social gatherings that are indoors or where people are close together
- work from home
- stay at least 6 feet away from people when out in public (indoors or outdoors)
- avoid physical contact in social situations, such as shaking hands, hugging or kissing
- wash your hands using soap and water for at least 20 seconds, especially after being out in public
- use alcohol-based hand sanitizer when soap and water aren’t available (or wash your hands as soon as you get home)
- avoid touching your face when your hands aren’t clean or you are out in public
- avoid contact with people you don’t know very well
- put the toilet seat down before flushing in a shared or public bathroom
- clean and disinfect surfaces that could be exposed to the virus, including doorknobs, light switches, faucet handles, and phones. Make sure you use a cleaning agent that is effective for killing viruses.
If you have a weakened immune system or other serious health problems, here are extra steps to protect yourself:
- Make a plan with your doctor to monitor for symptoms
- Avoid friends and family except those you live with or depend on for essentials. Otherwise, rely on your phone or computer to maintain contact.
- Have a plan with your loved ones or caregiver if you or they get sick
- Have the medications you rely on and order any you need in advance (to be delivered, if possible)
- Ask a friend or family member to shop for groceries for you
- Wash your hands (20 seconds with soap and water) even more often if you are exposed to others
What should I do if I develop symptoms?
If you develop more than one of the symptoms listed above, call your doctor. If you have severe symptoms, such as difficulty breathing, persistent chest pain or pressure, confusion or inability to awaken, or blueish color in the lips or face, you need to call 911. Tell the 911 operator that you think you have COVID-19 so the responders can take the necessary precautions to protect themselves.
People who experience mild symptoms can usually stay home and will recover in about 2 weeks. Do not just show up at the doctor’s office with symptoms: Call them first so you have tell them about your symptoms and any other health problems so that they can help decide what to do. If you do become sick, you can take the following steps to protect others:
- Stay home, unless you need essential medical care
- Wear a facemask when you are near others. (People caring for you should also wear a facemask).
- Stay away from others in your home as much as possible
- Cover your mouth and nose when you cough or sneeze, properly dispose of tissues, and wash your hands
- Monitor your symptoms and temperature
If you were not tested for COVID-19, you should follow those steps until at least one or two weeks have passed since you first noticed symptoms or your fever or other symptoms go away for 3 full days without medicine. If you have been diagnosed with COVID-19 based on test results, you should follow those same steps until you have 2 negative test results taken 24-hours apart, and your symptoms improve.
What if my other scheduled medical treatment is delayed?
When a person is diagnosed with a serious disease, they are likely to want treatment as soon as possible. If you don’t have COVID-19, you don’t want to be exposed to it during surgery, testing, or follow-up appointments. Treatment or testing may seem more urgent than it really is, but it is definitely more important than going to a restaurant, store, or beach. Some medical centers are overwhelmed with Covid-19 patients, and others are not. Talk to your doctor about what is the best strategy to get the treatment you need when it is safe to do so.
Wondering who to believe when experts – or politicians — disagree? Check out our new Myths vs. Reality chart.
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