Diana Zuckerman, Ph.D., Thomas Eagen, Ph.D., & Meg Seymour, Ph.D., Avni Patel, Angelica Estrada
Updated November 15th, 2022
The coronavirus can infect anyone, young or old, healthy or frail. Here’s what you need to know.
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. This virus is highly contagious and deadly with over 200 million confirmed cases and over 4.5 million deaths globally. As of September 19, 2022, there have been 95 million confirmed cases in the U.S. and over 1 million deaths.
Who is at risk of severe illness from COVID-19?
Older adults or people who have cancer and other serious health conditions are at increased risk for getting seriously ill from COVID-19. These individuals and their loved ones need to be especially careful to avoid getting infected and potentially hospitalized. The Centers for Disease Control and Prevention (CDC) has a list of health problems that put people at greatest risk of severe illness from COVID-19, which include underlying medical conditions such as: chronic kidney disease, chronic obstructive pulmonary disease (COPD), obesity (body mass index of 30 or higher), weakened immune system (from cancer or an organ transplant), serious heart conditions, sickle cell disease, and Type 2 diabetes. This risk has been shown to increase with age. Smoking also increases the risk of being seriously harmed by the virus.
A study published in the Journal of the American Heart Association in 2021 found that two-thirds of COVID-19 hospitalizations can be attributed to four cardiometabolic conditions: obesity, high blood pressure, diabetes, and heart failure. Many other medical conditions might contribute to an increased risk of severe illness, including asthma, developmental disabilities, high blood pressure, neurologic conditions (e.g., dementia), cerebrovascular disease (e.g., stroke), and pregnancy. A study published in the Journal of the American Medical Association (JAMA) Oncology in December 2020 of more than 6 million cancer patients, found that people diagnosed with cancer during the previous year are much more likely to die of COVID-19 compared to other COVID-19 patients. Several studies suggest that all cancer patients are at higher risk of dying, but the ones in most danger had been diagnosed with leukemia, non-Hodgkin’s lymphoma, or lung cancer. However, COVID patients who had been recently treated with chemotherapy were not more likely to die of COVID and COVID patients who had recently been treated with immunotherapy were less likely to die of COVID.
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. That’s why good protective masks are so important. For example, a study published in 2022 of people who had recently been exposed to someone with a COVID infection found that the person’s risk of developing a COVID infection was cut in half if both people wore masks. Although masks are rarely required in 2022, many individuals at higher risk due to their age or medical issues continue to benefit from wearing masks. 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. Becoming infected by exposure to people with no symptoms may be especially likely.
Unlike the flu, which is riskiest for the youngest children and oldest adults, infants and young children are much less likely to get seriously ill from the coronavirus than adults. Early in the pandemic, there were few known examples of the virus spreading in daycare centers that follow coronavirus safety standards. Nevertheless, by September 8, 2022, 14.6 million children had been diagnosed with the virus in the U.S. Fortunately, few children become so sick that they are hospitalized or die.
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. Becoming infected by exposure to people with no symptoms may be especially likely with the Delta variant, or if the asymptomatic person was vaccinated.
If I’ve had COVID-19, am I immune in the future?
A large Danish study of almost 4 million individuals (nearly 70% of the Danish population) found that having previously been infected by the COVID-19 virus provides protection against a repeated infection, particularly for people younger than 65 years. However, it is clear that people who previously had COVID-19 can become infected months later, and the strength and duration of immunity remain unclear.
Do we know how the virus is changing?
It is normal for viruses in the environment to change or mutate, resulting in new variants of the same virus. This is why the CDC recommends that adults and children receive a seasonal flu shot – to strengthen the body’s immune response against the variant with the potential to spread throughout a community. Many variants of the COVID-19 virus have emerged globally during the pandemic. The U.S. government is routinely monitoring for variants of concern that may show:
- Evidence of impact on diagnostics, treatments, or vaccines
- Widespread interference with diagnostic test targets
- Evidence of substantially decreased susceptibility to one or more class of therapies
- Evidence of significant decreased neutralization by antibodies generated during previous infection or vaccination
- Evidence of reduced vaccine-induced protection from severe disease
- Evidence of increased transmissibility
- Evidence of increased disease severity
The Delta variant, which was first identified in December 2020 in India, has been shown to be more contagious than the other virus strains and has quickly become the most dominant strain of COVID-19 globally. Some data reported by the CDC suggest the Delta variant is more than twice as contagious and may cause more severe illness. In two different studies from Canada and Scotland, patients infected with the Delta variant were more likely to be hospitalized than patients infected with the original virus.
In November 2021, the Omicron variant was first identified, and was soon shown to be more transmissible and more resistant to vaccines than other variants. By March 2022, a variant of Omicron, known as BA.2, had resulted in an increase in cases in Europe and had spread to the U.S. as well. BA.2 was even more infectious than Omicron and in early April accounted for 55% of new COVID infections in the U.S. The BA.5 variant soon followed in August, 2022. As of October 12, 2022, BA.5 accounts for 88% of cases in the U.S. and is the most contagious strain so far. Even if you have been infected with other strains, including previous Omicron strains, you can still get infected with BA.5. However, preliminary research suggests it is less likely to cause severe illness compared to other variants, and is more likely to cause upper respiratory symptoms such as sore throat, persistent cough, and runny nose.
What about the vaccines?
The COVID-19 vaccines that have been authorized or approved in the U.S. are designed to prevent serious illness, hospitalization, and death due to the virus. They are not 100% effective and some people who are fully vaccinated have become infected, sometimes called a breakthrough infection. These individuals have usually experienced mild illness, but some have become seriously ill.
On August 23, 2021, the Food and Drug Administration (FDA) approved Pfizer’s COVID-19 vaccine, which is now called Comirnaty, for the prevention of COVID-19 disease in individuals 16 years of age and older. This mRNA vaccine initially required two doses separated by 21 days, but as of late February 2022 the second dose is recommended to be 8 weeks later if possible, because immunity will last longer. The two-dose vaccine is also available under emergency use authorization (EUA) for children 5 years or older. Anyone ages 12 and older is encouraged to get a third “booster” dose.
On January 31, 2022, the FDA approved Moderna’s COVID-19 vaccine (now called Spikevax) for adults ages 18 and older. It also uses mRNA technology and initially included two doses administered 28 days apart, but as of late February 2022 is recommended to be 8 weeks apart if possible, because immunity will last longer. Boosters will be discussed in more detail below.
Two other vaccines are authorized for adults ages 18 and older under the FDA’s emergency use authorization (EUA). That includes the vaccine made by Janssen, a subsidiary of Johnson & Johnson. It is a single-dose vaccine, using an adenovirus instead of mRNA technology, and it is available under EUA. However, as of May 5, 2022, the FDA is restricting its Emergency Use Authorization to only include adults 18 and older who are not able to obtain or use either of the other two vaccines. In July 2022, the FDA authorized a 2-dose vaccine made by Novavax. As the newest vaccine, less is known about its long-term safety or effectiveness.
In March 2022, FDA declined to grant EUA for the Covaxin COVID-19 vaccine for use in children ages 2 to 18 years.
As of February 6, 2022, approximately 600 million doses of these three vaccines have been given in the U.S., with 67% of the entire U.S. population fully vaccinated. Rates of vaccination differ greatly by state and demographic traits.
As noted above, the Moderna and Pfizer vaccine are considered safer and more effective than the Johnson & Johnson vaccine. Nevertheless, all three vaccines have been shown to be effective at preventing serious illness from COVID-19. The vaccines are less effective for older people and those with a compromised immune system, such as those with organ transplants that take drugs to prevent organ rejection. While the initial studies of the three vaccines included few people under 18, pregnant women, people with compromised immune systems, or those with serious allergies, a study published in May 2021 in JAMA indicated that the vaccine has benefits that outweigh the risks for these individuals.
A major question is how long does the immunity from the vaccines last? In October 2021, FDA authorized a third primary dose of the Pfizer-BioNTech and Moderna vaccines under an EUA for individuals who are immunocompromised. This should be administered 6 months after the second dose. As of January 5, 2022, booster doses of the Pfizer vaccine are recommended for anyone ages 12 and older, and of the Moderna vaccine for anyone ages 18 and older. Both boosters should be given at least 5 months after their second dose. Although available for all adults, the CDC specifically recommends the booster for adults ages 50 and older. The booster dose of the Moderna vaccine is 1/2 the dose of the primary two doses, while the Pfizer booster dose is identical to the two previous doses. The CDC also recommends that adults 18 and older who received the Johnson & Johnson vaccine at least 2 months ago should get a booster shot.
A 2022 study, however, concludes that there is limited evidence that the vaccine is effective for children, particularly those aged 5-11 years. The study reports that vaccine efficacy declines overtime, and may be ineffective past the 34 day mark. While worrisome, this study does not negate the complete effectiveness of the vaccine, and experts still advise that children aged 5-11 years be vaccinated as it provides essential protection against severe cases of COVID-19. The results of the study highlight the need for alternative vaccine dosing schedules to ensure more layers of protection.
In October 2022, a study published in JAMA described the health outcomes of 1.6 million people served by the Veterans Health Administration (VA) who were fully vaccinated for COVID-19, including a booster shot. About 75% of those identified were 65 and older and more than 70% had a pre-existing health condition that put them at greater risk of severe COVID-19 infection. During the 24-week follow-up, only one in 1,000 (0.1%) were hospitalized with COVID or died. Even among those who were immunocompromised, less than one-third of 1% (one in 300) were hospitalized or died. For healthy adults over 65, the chance of hospitalization or death was 0.02% (2 out of 10,000). While there was no control group in this study and the study population was primarily men, it demonstrates the life-saving impact of full vaccination with boosters.
The FDA has also authorized “mixing and matching” vaccines for booster doses. For example, someone who got the Johnson & Johnson vaccine could get a booster dose of the Moderna (half dose) or Pfizer-BioNTech vaccines at least 2 months after their initial dose, or someone who got both primary doses of the Moderna vaccine could get a booster dose of the Pfizer-BioNTech vaccine 5 months after completing their two doses of Moderna.
It is important that anyone getting vaccinated is told about potential risks. Common side effects from the vaccines include: pain, redness, and swelling on the arm where you receive the shot; and tiredness, headache, muscle pain, chills, fever, and nausea throughout the rest of your body. Most side effects last only one day, and are typically stronger following the second dose of Pfizer or Moderna. In April 2021, there was a temporary pause to the use of the Johnson & Johnson vaccine after reports of rare blood clots, primarily in adult women younger than 50 years old. Following a review of the data, the FDA added a warning label to the vaccine about these rare blood clots. In December 2021, the CDC recommended that the Pfizer and Moderna vaccines be the preferred choice over the Johnson & Johnson vaccine, due to the risk of blood clots. However, the Director of the CDC, Dr. Rochelle Walensky, noted that despite the risk, “any vaccination is better than no vaccination” because the side effects are much less severe than the risks of COVID-19.
Sweden, Denmark, and Finland have paused the use of the Moderna vaccine in young people, due to the risk of myocarditis (inflammation of part of the heart muscle) and pericarditis (inflammation of the tissue around the heart), particularly in young men. However, one study found a 16 times higher risk of myocarditis among patients with COVID-19 compared to those without.
Some people are allergic to one or more of the ingredients of COVID-19 vaccines, and some people with compromised immune systems will find the vaccine is much less effective for them compared to people with well-functioning immune systems. In December 2021, the FDA issued an EUA for a new AstraZeneca monoclonal antibody drug called Evusheld, which is intended for those ages 12 and older who have compromised immune systems, such as those with cancer. The drug (taken as two injections) contains laboratory-made antibody proteins, and is intended to help reduce the risk of COVID-19 infection for up to 6 months. The FDA is careful to note that this drug is not a substitute for vaccination, which is the best form of protection from infection. Instead, Evusheld is meant to help provide protection to those who have a compromised immune system that makes them even more vulnerable to infection.
With the rise of variants that have increasing rates of infection, some vaccine manufacturers have been working on booster’s that directly target current strains of the coronavirus.
On August 15, 2022, The U.K. became the first to authorize a vaccine that targets both the original COVID-19 virus from 2020 as well as the increasingly common Omicron BA.1 variant. The vaccine made by Moderna was approved by Britain’s Medicines and Healthcare products Regulatory Agency and their scientific advisory body, the Commission on Human Medicines. The booster, Spikevax bivalent Original/Omicron, is 50 micrograms, with half dedicated to each strain. It had side effects similar to the original Moderna booster dose.
A week later on August 22, 2022, Pfizer and BioNTech followed suit in in the U.S., submitting an Emergency Use Authorization for their Omicron BA.4/BA.5 bivalent vaccine for people 12 and older. On August 31, 2022 the FDA approved the amended EUA for the Moderna and Pfizer-BioNTech COVID-19 bivalent vaccines as a single use booster at least two months following a primary or booster dose. As of October 12, 2022, the Moderna COVID-19 Bivalent is authorized for individuals 6 years of age or older and the Pfizer-BioNTech COVID-19 Bivalent is authorized for individuals 5 years of age and older.
The U.S. Department of Health and Human Services and the U.S. The Department of Defense purchased 66 million doses of Moderna’s vaccine in addition to the previous 105 million bivalent COVID-19 boosters from Pfizer the U.S. purchased earlier this year. Bivalent vaccines are looking to become the norm however, as the Food and Drug Administration’s Vaccine Advisory Committee voted to require an Omicron component in this upcoming 2022 season’s booster dose.
Can children be vaccinated against COVID-19?
The short answer is, yes! The FDA has authorized the emergency use of the Pfizer and Moderna vaccine for children 6 months through 5 years, and 5 years through 11 years. The FDA reviewed the data on the studies of children taking the vaccines and consulted an independent Vaccine Advisory Committee before making the decision.
Vaccines for Children between the ages of 6 months and 5 years
As of June 17, 2022, the Moderna and Pfizer vaccines are authorized for the prevention of COVID-19 disease in children ages 6 months and older. Although the COVID vaccines do not always prevent infections in children or adults, they are expected to protect against severe illness and death.
The Moderna COVID-19 vaccine is administered to children ages 6 months to 5 years in two doses, one month apart. A third dose is administered at least one month after the second dose for immunocompromised children. The Pfizer-BioNTech COVID-19 vaccine is administered to all children ages 6 months to 5 years in three doses. The initial two doses are administered three weeks apart, and the third is administered at least eight weeks after the second dose. All doses of both vaccines are lower than the doses for adults.
Effectiveness and Safety of the Moderna COVID-19 Vaccine
In two ongoing, blinded, and randomized clinical trials, the vaccine was 51% effective in preventing COVID-19 infection in children 6-23 months, and 37% effective for children between 2 and 5 years of age. The most commonly reported side effects for children between 6 months and 5 years were: pain, redness and tenderness/ swelling at the injection site, and fever. In children between 6 and 36 months, commonly reported side effects were crying, irritability, sleepiness, and loss of appetite. For example, 11% of children 6-23 months experienced any fever after the first dose, and almost 15% experienced any fever after the second dose. Children 37 months and older experienced fatigue, nausea, headache, muscle aches, chills, and joint stiffness. Fatigue was very common, with 48% of children 37 months-5 years experiencing any fatigue after the second dose.
Effectiveness and Safety of the Pfizer-BioNTech COVID-19 Vaccine
Studies show that the immune response to this vaccine in children ages 6-23 months and 2-4 years is comparable to the immune response of older participants. The most commonly reported side effects in these age groups are irritability, decreased appetite, fever, and tenderness/swelling at the injection site. For example, 51% of children ages 6-23 months experienced any irritability after the first dose, and 47% experienced any irritability after the second dose. In vaccine recipients aged 2-4 years, additional side effects included fever, headache, and chills.
Since the side effects were expected to be short-term, the FDA decision to authorize the vaccines for children and adults was based on just a few months of safety data. As was the case for adults, safety monitoring of the vaccines for children is ongoing.
Vaccines for Children between the ages of 5 and 11 years
On October 29, 2021, the FDA approved the emergency use of the Pfizer-BioNTech vaccine for the prevention of COVID-19 disease in children ages 5 through 11 years. This vaccine is administered in 2 doses, 3 weeks apart, at a lower dose than the vaccine for adults.
Effectiveness and Safety of the Pfizer-BioNTech COVID-19 Vaccine
The vaccine was 91% effective in preventing severe COVID-19 infection in children 5 through 11. An ongoing, randomized study of approximately 4,700 children ages 5 through 11 years is being conducted in the U.S., Finland, Poland, and Spain. The FDA compared the immune response of 264 children in this age group and compared them with the immune responses of participants ages 16 through 25, determining that the immune responses in children were similar to the older participants.
The vaccine’s safety was studied in an ongoing clinical trial of approximately 3,100 children ages 5-11. In addition, 1,444 participants were monitored for safety at least 2 months after the second dose. Commonly reported side effects included: “injection site pain (sore arm), redness and swelling, fatigue, headache, muscle and/or joint pain, chills, fever, swollen lymph nodes, nausea and decreased appetite”. More children reported side effects after the second dose. For example, 34% of children ages 5 through 11 experienced any fatigue after the first dose, and 39% experienced any fatigue after the second dose. Fewer than 1% experienced more severe side effects, such as developing a rash or swelling triggered by an allergy. Almost all of the side effects reported went away within one to two days and were described as generally mild to moderate in severity.
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. These symptoms have been reported in people with COVID-19:
|· Fever or chills
· Shortness of breath or difficulty breathing
· Muscle pains
· New loss of taste or smell
· Sudden confusion (delirium)
· Skin rash, redness on toes/fingers
|· Chest pains
· Sore throat
· Congestion or runny nose
· Nausea or vomiting
· Skipping meals
· Abdominal pains
· Changes in the mouth or tongue
Studies out of the United Kingdom show that the most common symptom associated with COVID-19 is a sore throat, with fever and loss of smell becoming rarer in patients. Tim Spector, a professor of genetic epidemiology at King’s College London, reported that “COVID starts in two-thirds of people with a sore throat,” which is something to keep an eye out for if you think you may have COVID.
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?
If you live in the U.S., the best way to protect yourself and others it to get one of the 3 vaccines available. The vaccines are widely available throughout the U.S. in multiple locations from community health centers to local pharmacies. Current treatment options for COVID-19 are limited. There are no proven cures, so don’t be fooled by claims, regardless of the source. The FDA has approved one drug treatment for COVID-19 and has granted EUAs for 12 drug treatments.
What if you are pregnant? Research shows that COVID infection is dangerous to pregnant women and that vaccinating pregnant women is safe. For example, a study of more than 24,000 newborns, of whom almost 17,000 were exposed to a mRNA COVID vaccine in the first or second trimesters when their mothers were vaccinated, found no differences in preterm birth rates, neonatal hospitalizations, congenital abnormalities or infant mortality. A small study found that most infants born to COVID-vaccinated mothers had persistent antibodies at 6 months, compared with infants born to mothers who had been infected with SARS-CoV-2.
In contrast to vaccination, a COVID infection increases the chances of serious harm for pregnant women. A retrospective study of more than 14,000 pregnant women found that those with COVID infections were more likely to die or have serious illness related to hypertensive disorders of pregnancy, postpartum hemorrhage, or infection other than SARS-CoV-2 compared to pregnant women who did not have a COVID infection (13% vs 9%). All 5 maternal deaths in the study were women who were infected with COVID.
What treatments are safe and effective?
In late December 2021, the FDA authorized two prescription treatments in pill form that can be taken at home for mild to moderate COVID-19 infections. The aim of each medication is to prevent these infections from progressing to severe infections that lead to hospitalization and/or death. Each drug was only tested on unvaccinated adults with underlying medical conditions that make severe infection more likely, such as diabetes. The preferable treatment is Pfizer’s medication, Paxlovid. Although the FDA authorized Paxlovid without a public meeting, it was awarded an EUA based on research data which indicated that Paxlovid reduces hospitalization or death by 88% for patients at high risk if taken shortly after COVID symptoms develop. However, newer
In contrast, the FDA held an advisory committee meeting in November 2021 to review the data on Molnupiravir, Merck’s antiviral medication because the study results were more controversial for Molnupiravir than for Paxlovid. The potential benefits of the drug appear very small, with only a 3% absolute difference in the rate of hospitalization or death between those taking the drug and those taking a placebo. There are also potential risks of Molnupiravir, especially for pregnant women, but also the risk of creating a “breeding ground” for variants of the virus. To read NCHR’s statement to the committee about Molnupiravir, click here. The Advisory Committee voted 13 in favor and 10 against issuing an EUA for the drug, and on December 23 2021, the FDA officially issued an EUA for Molnupiravir, “For whom alternative COVID-19 treatment options authorized by FDA are not accessible or clinically appropriate, and specifically cautioning against its use in pregnant patients. For those reasons, NCHR is questioning FDA’s authorization of Molnupiravir.
The FDA approved the antiviral drug remdesivir, which has been found to help very ill adults and children 12 years of age or older reduce the number of days of hospitalization. In one study sponsored by the National Institute of Allergy and Infectious Diseases showed a significantly faster time to recovery in patients taking remdesivir (about 10 days) compared to the placebo group (about 15 days).
The FDA has authorized several monoclonal antibody treatments for individuals with mild to moderate illness due to COVID-19. Bebtelovimab was recently authorized as the only monoclonal antibody to cover all mutations of Omicron. This treatment has been shown to reduce the risk of illness progressing to severe illness, including hospitalization or death. A different monoclonal antibody has been authorized to prevent COVID for individuals who were exposed. Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off harmful antigens such as viruses. In December 2021, the drug companies that make the monoclonal antibody treatments casirivimab/imdevimab and bamlanivimab/etesevimab stated that laboratory tests suggest their treatments may be less effective against the Omicron variant. Early evidence suggests that sotrovimab, another monoclonal antibody treatment, may be effective against the Omicron variant.
Another possible treatment is blood plasma from people who recovered from COVID-19. Known as convalescent plasma, this blood product contains antibodies that help fight the virus. In March, 2021, convalescent plasma was given emergency FDA authorization for treating hospitalized COVID-19 patients early in the disease course. However, studies published in the summer of 2021 indicated that this treatment was not effective, and in late 2021, the WHO recommended against the use of convalescent plasma as it is not shown to have any benefit. On December 28, 2021, the FDA revised its EUA to be limited to COVID-19 convalescent plasma with high titers of antiSARS-CoV-2 antibodies only for COVID-19 patients with immunosuppressive disease or receiving immunosuppressive treatment.
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. Known as convalescent plasma, this blood product contains antibodies that help fight the virus. Convalescent plasma currently has emergency FDA authorization for treating hospitalized COVID-19 patients early in the disease course. However, studies published in the summer of 2021 indicated that this treatment was not effective.
Ivermectin is a drug approved by the FDA for human use to treat infections caused by internal and external parasites, but it has not been approved to treat COVID-19. A 2021 study of 476 patients found that ivermectin is not more effective than placebo to reduce the symptoms of COVID-19. Although a preprinted study (not peer reviewed) suggested it would drastically reduce deaths from COVID, that preprint was withdrawn in July 2021 because of irregularities in the data. Despite the lack of data showing effectiveness, the drug has been widely promoted as a potential treatment to the virus, with families suing hospitals that refuse to prescribe it. Concerns about ivermectin are based on evidence of dangerous side-effects. Calls to poison control centers due to ivermectin ingestion have increased five-fold from their pre-pandemic baseline, leading the CDC to issue an emergency health advisory. Several organizations have issued public statements against the use of ivermectin as a treatment to COVID-19 including the National Institutes of Health (NIH), World Health Organization, FDA, and the American Medical Association (AMA).
A study in Brazil found that fluvoxamine, a common antidepressant also known as Luvox, may help reduce the likelihood of being hospitalized from a COVID-19 infection. About 1500 adults diagnosed with COVID-19 were assigned to take either fluvoxamine or a placebo for 10 days. Those who took the antidepressant were less likely to be hospitalized than those who took the placebo, with only 11% of those in the fluvoxamine group hospitalized, compared with 16% of those taking the placebo. More research is needed in order to know if fluvoxamine might be an effective treatment for the U.S. population. In late December 2021, Dr. David Boulware of the University of Minnesota submitted an EUA application to the FDA for fluvoxamine as a COVID-19 treatment. Since a submission by a physician rather than a pharmaceutical company is unusual, it may take several months for the FDA to make a decision.
Fluoxetine (Prozac) is another antidepressant that could potentially help patients infected with COVID-19. One study of people who tested positive for COVID compared those who were already taking either fluoxetine or fluvoxamine to people who did not regularly take either of those antidepressants. The researchers found that almost 10% of those taking fluoxetine died, compared with just over 13% of people not taking one of the antidepressants. Since other factors could explain the difference in COVID deaths, clinical trials are necessary to determine if Prozac decreases the chance of dying for those with COVID-19.
Research is continuing to find out which of these treatments are safe and effective and for which patients.
What else can I do to stay safe?
In addition to getting vaccinated, you may want to change who you spend time with and the types of activities you participate in.
- Avoid spending time with others if you or any of them have symptoms of COVID-19.
- For people who have tested positive for COVID-19 and have no symptoms at all, the CDC recommends (as of December 2021) isolating for 5 days, followed by 5 days of wearing a mask while near other people to reduce the risk of spreading the virus to others. The CDC says isolation is the appropriate behavior after a confirmed infection.
- This CDC recommendation is highly confusing and controversial. We agree with experts who say the shorter 5-day isolation should depend on being vaccinated, having a negative COVID test after 5 days, and continued use of an effective mask after the 5 days. After experts criticized the December announcement, on January 4, 2022, the CDC modified their guidelines to recommend testing at day 5 for those who have access to a test and “want to” use it. Since wanting to test is not good guidance, and since the CDC acknowledges that people diagnosed with the virus may still be infectious after day 5, we agree with experts who say that a negative test should be required before someone leaves isolation prior to day 10. People at higher risk of severe COVID-19 or who live or work near others at higher risk should be especially cautious, since the 5-day limit is based on the average risk of exposures, not all exposures.
- For people who are fully vaccinated and who were in close contact (within 6 feet for at least 15 minutes) with someone with COVID-19, the CDC now recommends (as of December 2021) that you get tested 5-7 days after exposure even if you don’t have symptoms. CDC recommends that fully vaccinated people don’t need to quarantine if they don’t have symptoms, but should wear a mask for 14 days or until their test result is negative. Quarantine refers to the time following close contact with someone known to have COVID-19 if you do not have test results confirming COVID.
- For anyone who is exposed, the best thing to do is get tested for SARS-CoV-2 on the 5thday after exposure. If you have symptoms, immediately quarantine until a negative test result indicates you do not have the COVID-19 virus.
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. Things to consider:
- 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 safer if it isn’t crowded. It can be heated, but not if it has walls all around and a ceiling.)
- What’s the length of time that you will be interacting with people? (Shorter is better)
The CDC recommends all individuals, both vaccinated and unvaccinated, wear a face mask or covering when indoors around others. Research conclusively shows that face masks that cover 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. Paper surgical 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 prevent infection or serious symptoms for the person wearing the masks.
Other ways to reduce your risk of contracting COVID-19 include:
- 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
- A lower priority would be to clean and disinfect surfaces including doorknobs, light switches, faucet handles, and phones. An antibacterial cleaning agent won’t kill a virus, so try to find one 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
- 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
For healthcare workers on the frontline of the COVID-19 pandemic, a study from Cantonal Hospital St. Gallen in Switzerland reported that workers who wore a respirator mask had a 21% likelihood of infection versus those with surgical masks who had a 35% likelihood of infection. However the study did not infer causality, so there isn’t concrete evidence that respirator masking policies should be stricter, but healthcare workers at risk could benefit from wearing respirators while caring for their patients with SARS-CoV-2.
What should I do if I develop symptoms?
If you develop more than one of the symptoms listed above, get tested for COVID, using an at-home test. That’s the fastest way to get results, but keep in mind that the rapid tests (whether at home or anywhere else) are not as accurate as the PCR test. If you have symptoms but your rapid test is negative, test yourself again a day or 2 later, because the tests get more accurate after a few days of symptoms.
If you have symptoms that worry you, call your doctor whether or not you test positive. 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. People are discouraged from simply showing 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:
- Get tested for COVID-19, ideally with a PCR test to confirm the results (positive or negative) of your at-home test
- Wear a face mask
- Stay home, unless you need essential medical care
- 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.
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