Let’s Talk About the Novel Coronavirus

COVID-19 may be the defining (and scariest) global crisis of our time. Your best defense is knowledge and preparedness. Minus any fake news.

by Erin L. Boyle Health Writer

Reported in almost every country in the world and in all 50 states, the novel coronavirus has created widespread panic and an almost apocalyptic vibe. The 24/7 news updates—often sharing conflicting advice and information—have led to fearmongering, confusion, and a ton of anxiety. And, after a summer breather of lowered infection rates in the original U.S. hot zones (even as other regions of the country saw initial spikes), we're watching the numbers creep up again. So, the best thing to do right now is STAY AT HOME as much as you can and, yes, WEAR A FACE MASK when you're out in public, gathering in groups, and social distancing is not possible. Also, read up! Our coronavirus guide, complete with FAQs, comes from a panel of top pros and cites dozens of studies so you can protect yourself, and others, with the very latest information available.

COVID-19

Our Pro Panel

We went to some of the nation's top experts in infectious disease to bring you the most up-to-date information possible.

Amesh A. Adalja, M.D.
Amesh A. Adalja, M.D.

Amesh A. Adalja, M.D.

Internist specializing in infectious diseases and critical care

University of Pittsburgh Medical Center

Pittsburgh, PA

Jeanne D. Breen, M.D.
Jeanne D. Breen, M.D.

Jeanne D. Breen, M.D.

Infectious disease specialist, Assistant Clinical Professor, Laboratory Medicine

Yale School of Medicine

New Haven, CT

John Swartzberg, M.D.
John Swartzberg, M.D.

John Swartzberg, M.D.

Clinical Professor, Emeritus

UC Berkeley - UCSF Joint Medical Program, Infectious Diseases & Vaccinology Division, UC Berkeley School of Public Health

Berkeley, CA

COVID-19
Frequently Asked Questions
Can coronavirus be carried by dogs or cats?

Yes, cats and dogs can get coronaviruses, but they can’t give you their versions. Although it's rare, there is some evidence that a dog, cat, or any pet for that matter may get COVID-19 from human contact. There was one reported case in Hong Kong of a dog infected with this new strain, and at least one case in the U.S.

How long is coronavirus contagious?

We don’t yet know. Clinicians found viral RNA—COVID-19's genetic material; so, like, its calling card—20 days after onset of symptoms in some COVID-19 patents, meaning those with the disease were still “shedding” the virus that many days out. And the virus was detectable until death in those who lost their lives to the illness. The longest time COVID-19 was detected in preliminary study? 37 days. According to the CDC, if you’ve had no fever for 72 hours (without needing medicine to reduce it), your symptoms have improved, and at least seven days have passed since your symptoms first appeared, you can leave home (even if you can’t get a follow-up test).

Where did coronavirus come from?

Bats. That’s the likely source of the novel, or new, strain of coronavirus called SARS-CoV-2. It’s possible that bats had the virus and passed it to another animal (possibly an animal called the pangolin), which then passed it to humans, who then passed it to each other. It might have originated at Huanan Wholesale Seafood Market or other area markets in Hunan, China, and first appeared in December 2019.

How can you avoid the novel coronavirus?

Wash your hands with soap and water for at least 20 seconds, making sure to soap every part of your hands, regularly! Which means: after going to the bathroom, before eating, after being out in public. Use hand sanitizer with at least 60% alcohol if you don’t have access to soap and a sink, making sure to cover your whole hands and rubbing them together until they feel dry. Avoid touching your eyes, nose, and mouth with unwashed hands. Cough or sneeze into your elbow, to prevent droplets from scattering 6 feet away from you. And finally, practice good social distancing. Maintain 6 feet from yourself and anyone else. Stay home, flatten the curve.

What Is a Coronavirus, Exactly?

So just what is this illness? The novel coronavirus is a new disease strain in a family of viruses called “coronaviruses,” which were discovered in the late 1960s. They cause everything from mild to severe upper-respiratory tract illnesses (plus a range of other documented symptoms) and are zoonotic, meaning they’re transmitted from animals to people.

The name comes from the way the virus looks under a microscope: It has crown-like—or “corona,” the Latin word for crown—spikes on it surface, to better grab hold of our cells. Humans experience seven different strains of coronaviruses. Turns out, it’s quite likely you’ve already had one of them—the common cold.

This latest version—now a pandemic (meaning it’s spread around the world)—is called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The illness that the SARS-CoV-2 virus causes is COVID-19. It was discovered in December 2019 in the city of Wuhan, China, in the Hubei province. Most of us are colloquially calling this new virus the “coronavirus,” and technically that’s accurate because it is a member of that family. But for the record, the virus’ correct name is COVID-19.

Terms describing the coronavirus include: coronavirus, COVID-19, 2019-nCoV, and SARS-CoV-2
Nikki Cagle

Two other severe strains of coronavirus—severe acute respiratory syndrome (SARS-CoV, or just SARS) and Middle East Respiratory Syndrome (MERS-CoV, or just MERS)—broke out in the last two decades in more than 20 countries, leading to some 1,600+ deaths. While COVID-19 seems more infectious than those two, it also seems less deadly (thank goodness).

The transmission sources of this coronavirus disease are still under investigation, but it appears to come from bats, which then pass it to another, intermediary, animal—possibly a pangolin, a type of anteater that looks like an armadillo, which happens to be the most heavily trafficked mammal in the world. From there, it moves to humans.

What Are the Main Symptoms of the Coronavirus?

First off, the World Health Organization (WHO) defines a suspected case of COVID-19 as a person with acute respiratory illness, where the most common symptoms are fever, dry cough, and fatigue. According to the Centers for Disease Control and Prevention (CDC), these symptoms are often mild and begin gradually, and first appearing two to 14 days after exposure to the virus. However, as you’ll see from the percentages below, not everyone who has COVID-19 experiences those symptoms, or even any of the symptoms.

Here’s the thing to understand about COVID-19: The severity and duration, or whether you get any specific symptom at all, is based on how your immune system handles the disease. It’s why it’s so difficult for doctors to give specifics about how long chills will last or how bad a cough might be. Maddeningly, the coronavirus likes to get personal.

The symptoms we’re presenting here come from the leading WHO report on 55,924 laboratory-confirmed COVID-19 cases in Wuhan, China. The most commonly cited symptoms of COVID-19 are:

  • Fever. This is the most prevalent symptom, occurring in about 88% of people. Our normal body temp is around 98.6 degrees Fahrenheit. A fever would be considered in the 101-104 range.

  • Cough. About 67% of people in Wuhan had this symptom, which has been described as a dry cough that happens intermittently. That said, your cough might be different. It might be dry and called “unproductive,” meaning with no mucus. Or it might be wetter, producing mucus whenever you cough. You might cough so much, it hurts. You might not.

  • Shortness of breath. This was reported in about 18% of cases. Your immune system response and health risk factors will establish your baseline for this as well. So, say you have emphysema, you might be short of breath during the day already, but if you’re an athlete, you wouldn’t be winded until you ran a distance. Both are typical. What isn’t typical? If you have a hard time breathing while doing daily activities that don’t typically cause an issue. Then it might be COVID-19-related.

  • Fatigue. You know the deep exhaustion that can hit during the flu? This feels the same, and about 38% of people with COVID-19 experience it.

  • Sputum production. Occurring in 33% of cases, this mix of saliva and mucus is coughed up from the respiratory tract.

  • Sore throat. This is typical throat pain, like the kind you might have with a cold. About 14% of people with COVID-19 had a sore throat.

  • Muscle and joint pain. Joint aches happen in 14.8% of cases. THe areas you feel pain can vary from one person to the next.

  • Headaches. Feels like your basic headache—your head just hurts, and hurts bad—and it’s coupled with other COVID-19 signs, so you’d know it’s not just a stress headache from all the bad news. Thirteen percent of cases include headaches as a symptom.

  • Chills. Oh, that familiar feeling you get with the flu. It happens with COVID-19 too, in about 11% of people, sometimes involving full-body shakes. Different people will have them for different durations.

  • Loss of sense of smell and taste. More research should hopefully show us why this is a problem. (We know one patient who was able to down a full tablespoon of Tabasco and not even notice it.)

In late June, the CDC added three new symptoms to this official list. They include:

  • Nausea or vomiting. You can see why people keep saying the coronavirus is like the flu. The symptoms are similar. While nausea and vomiting happen with COVID-19, they’re not always routine: 5% of patients threw up or felt like they might in Wuhan.

  • Nasal congestion and/or runny nose. Stuffy noses can happen with COVID-19, but they’re not as typical as other symptoms, occurring in nearly 5% of cases studied.

  • Diarrhea. As with vomiting, this was a smaller number too, at 3.7%. Still, further research is showing that this symptom might be more prevalent than first thought. Another published report of 138 patients in a Wuhan hospital found up to 10% had diarrhea or vomiting. To make things even more confusing: A new study published on March 30 in the American Journal of Gastroenterology found that some people with a mild form of COVID-19 experience diarrhea first—with COVID's typical respiratory symptoms not showing up till days later, or ever.

Symptoms of coronavirus include fever, shortness of breath, cough, sore throat, fatigue, joint pain, sputum production, and headaches
Nikki Cagle

There are other symptoms that have been reported anecdotally by doctors and people who’ve tested positive for COVID-19. They include:

  • Hemoptysis. This is an awful one. It’s when you cough up blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs. It occurs in 0.9% of cases.

  • Conjunctival congestion. Otherwise known as "pink eye," this is when your eyes are red and a watery discharge keeps flowing out of them. A recent study out of Wuhan of 216 hospitalized children with COVID-19 showed how 22.7% (49 kids) had this symptom. There is a also a well-documented connection between pink eye and respiratory viral infections, according to the Cleveland Clinic.

  • Toe bumps. Dermatologists are researching a peculiar new skin rash that may be tied to COVID-19. Some coronavirus patients are reporting red and purple bumps on their toes, which are painful to the touch and can become inflamed within a matter of days. This condition, which most commonly occurs in young people and seems to appear before other symptoms, has been informally nicknamed “COVID toes.”

Below, a few more symptom stats incoming from the WHO:

  • More than 80% of people with COVID-19 have mild, uncomplicated illnesses and don’t need to go to the hospital.

  • About 14% develop severe disease requiring hospitalization and oxygen support, and, of those, up to 30% require admission to an intensive care unit (ICU).

Then there are the growing number of COVID-19 "long-haulers." These include the tens of thousands of people (numbers are still anecdotal and difficult to assess) who may (or may not have) tested positive for coronavirus, experienced the range of familiar COVID-19 symptoms, and then either a.) rebounded briefly, only to battle those symptoms all over again, or b.) never fully rebounded at all, suffering from chronic fatigue, unusual heart rhythms, shortness of breath, and additional documented ailments for weeks or even many months after the initial onset of illness. According to JAMA, many are health care workers who were exposed to heavy viral doses early on in the pandemic. UK researchers estimate that 10% of all COVID-19 patients will experience prolonged symptoms. As scientists and doctors race to gain some answers, to date some 110K long-haulers gather on the Facebook forum Survivor Corps to discuss their experiences and offer support.

As you can see, the way this illness plays out is a bit all over the place. COVID-19 can cause life-threatening symptoms, worsening to pneumonia; it may cause long-term, possibly chronic symptoms; or you can feel just fine and still have this virus. Case in point: Study authors looking at COVID-19 cases on the cruise ship Diamond Princess found that 19.2% of people who tested positive for the virus on the ship were asymptomatic.

How Is the New Coronavirus Transmitted?

According to the Centers for Disease Control and Prevention (CDC), the principal mode by which people are infected with COVID-19 is through exposure to respiratory droplets carrying infectious virus.

Such exposure can occur in one of three ways:

  1. Contact transmission: This infection pathway is exactly what it sounds like: People can pick up the virus by touching other infected people or surfaces that are contaminated (like doorknobs, railings, ATM machines, or faucets), then touching their hands to their nose, eyes, or mouth.

  2. Droplet transmission: The virus can also spread through exposure to large or small droplets of the coronavirus expelled into the air when an infected person talks, sings, or sneezes. There is some evidence that suggests louder talking and singing (like one does at choir practice or in loud bars) puts more droplets into the air, creating a higher viral load and upping transmission risk. This type of transmission occurs when you are close to an infected person, generally within 6 feet.

  3. Airborne transmission: After much back-and-forth on the subject, the CDC has finally agreed that, yes, airborne transmission of this virus is a real thing. That means that small droplets and particles of COVID-19 can become aerosolized and hang in the air across distances greater than 6 feet (think of it like invisible clouds of cigarette smoke) in poorly ventilated spaces for (typically) hours. (According to Harvard University, such COVID clouds can linger for roughly three hours.) Several well-documented "super-spreader" events are thought to be linked to airborne transmission of this virus.

It's important to note that these transmission pathways are not mutually exclusive, and that information about COVID-19 is ever-evolving. As more people around the world get the illness, health care professionals share what they’re learning in real time, and researchers and major health organizations rush to publish the latest accurate data, we'll continue to share all updates with you.

Here’s how we know you can get COVID-19:

Below, a more detailed break down of various transmission pathways:

  1. Coughing, sneezing, talking, singing, exhaling. If a person with COVID-19 coughs, sneezes, sings, or even exhales within about 6 feet of you, droplets of varying sizes (large, medium, and small) from their nose (mucus) or mouth (saliva) can infect you when you inhale them into your lungs.

    Researchers reported in the New England Journal of Medicine in mid-March 2020 that, in a controlled environment, those droplets can stay in the air—so, airborne—for up to three hours, but more real-world study is needed to determine how realistic this transmission is.

  2. Touching someone sick. If you hug or shake hands, you can transmit infected droplets (like from the hand that they coughed into) into your body, if you then rub your nose, mouth, or eyes.

    COVID-19 can’t be transmitted simply by touching someone’s skin. Just rubbing against an infected person's skin won’t give you the virus unless a) the other person had droplets on their skin, and b) you then rub it into your nose, mouth, or eyes. Still: Be careful!

  3. Touching a surface or object with infected droplets. Keep in mind, the CDC reports that while you can possibly get COVID-19 from touching an infected surface and then touching your nose, mouth, or eyes, the most common way to catch it is through person-to-person transfer. With that knowledge...

    A New England Journal of Medicine article found that COVID-19 stays on the following objects (called fomites) for various amounts of time, with various levels of contamination:

    • Copper: 4 hours

    • Cardboard: 24 hours

    • Plastic: 3 days

    • Stainless steel: 3 days

    Other studies, looking at coronaviruses in general, and how long they live on surfaces (which is likely how long this strain might, too), found they lived on:

    • Paper: 4 to 5 days

    • Cloth: 4 days

  4. Gathering in groups indoors. Airborne transmission is thought to occur in indoor spaces among groups of people (when someone present is both infected and shedding virus, another way of saying they're contagious), especially venues with poor ventilation or recirculated, unfiltered air. Think small restaurants with tables positioned near air vents, crowded concerts or packed church assemblies, indoor sporting arenas, or even busy gyms where exercising patrons are breathing hard and heavy as they work out.

Here’s how you might get it (but we’re not sure):

Feces: Officials are recommending that anyone in your house with the virus use their own bathroom—if possible—to reduce potential infection of others in the house. Early research seems to indicate that the virus is “shedded,” or released, through your stool, and since one COVID-19 symptom is diarrhea, experts are studying whether it’s transmitted through feces. As for urine, nobody knows yet whether it’s a transmitter, either; it was one way the 2003-2004 SARS virus was shed, so more study is happening.

Here’s what's unlikely (but uncertain):

  1. Sexually. While you can get this novel coronavirus from kissing—in which you share saliva droplets mouth-to-mouth—it is still a question mark whether it can be sexually transmitted. A small study found it in the semen of men diagnosed with the disease, but there was no evidence partners were infected this way.

  2. Mother-to-baby. When a pregnant woman passes a virus on to her baby, it's called vertical transmission. Studies on COVID-19 have found both positive and negative correlations in this regard.

  3. Blood. Unlike other viruses, like Hepatitis C, it doesn’t appear that you can be infected with COVID-19 through blood exchange.

  4. Water. Certain diseases, such as cholera, can be caught by drinking water infused with harmful bacteria. COVID-19 doesn't seem to transmit through H20.

  5. Food. It appears that food won’t give you the virus, so takeout should be OK—though if you want to double-down on safety, you can recook your eats and bring them up to temperature (depending on the specific kind of food) to ensure all pathogens are killed.

How Long Is the Incubation Period of the Coronavirus?

The signs and symptoms of COVID-19 set in between two and 14 days after first exposure. It’s this wide range that makes the virus so tricky to contain: People can be walking around with the virus and not know it.

And it appears that this disease can still be spread before you have symptoms, or even if you never show symptoms (the CDC says up to 25% of people with COVID-19 will fall in that latter category). All this to stress the critical importance of social distancing.

If you do get COVID-19 symptoms, researchers found that the median incubation period—the time between when you’re exposed to the virus and when the first signs appear—is just over five days, and that a person is most infectious four to seven days after they catch COVID-19, per a study published in the Annals of Internal Medicine. The researchers also reported that 97.5% of people who develop symptoms do so within 11.5 days of infection.

Symptoms often start mild and gradually, then increase in intensity.

Why Does COVID-19 Seriously Impact Older Adults?

It's true: People who are 60 and older are at high risk for serious complications from COVID-19, based on data from Wuhan. In the U.S. alone, 68.7 million Americans are 60 and above.

Why is age likely an issue with COVID-19? As we age, the immune system responds more slowly to infections, which can increase your chance of becoming sick. Your immune system has fewer immune cells at 60 and above, so you heal more slowly, too.

The highest number of fatalities reported in Wuhan was in people 80 and older, which accounted for nearly 15% of deaths. For those 50-59, the fatality rate was 1.3%, jumping up to 3.6% for those 60-69 years of age, and 8% for those 70 to 79.

In the U.S.? A staggering eight out of 10 deaths from COVID-19 have been in those 65 and older. In adults with confirmed COVID-19 in America:

  • Estimated percent requiring hospitalization

    • 31-70% of adults 85 years old and older

    • 31-59% of adults 65-84 years old

  • Estimated percent requiring admission to an intensive care unit

    • 6-29% of adults 85 years old and older

    • 11-31% of adults 65-84 years old

  • Estimated percent who died

    • 10-27% of adults 85 years old and older

    • 4-11% of adults 65-84 years old

Are Pregnant Women at Higher Risk From Coronavirus? What About Newborns?

Information about COVID-19 and pregnancy is evolving in real time. In late June the CDC updated its guidelines to confirm that pregnant women with a COVID-19 infection are at higher risk for serious illness, intensive care hospitalization, and mechanical ventilation before recovering—but share the same mortality risk with women who are not pregnant and get the virus. This means they're more likely to battle a nasty case of the disease but do not have a higher risk from dying from it.

Based on the lastest counts available, there are about 10,000 cases of pregnant women who tested positive for COVID-19 in the U.S., with a disporportionate number of them being Hispanic or non-Hispanic Black women. Nearly 3,000 were hospitalized and 26 died.

How newborns become infected is still murky—the jury is out on transmission from mother to baby before, during, or after birth. For now, the likliest transmission path is from a newborn's exposure to respiratory droplets from a mother, other caregivers, visitors, or healthcare personnel with COVID-19, reports the CDC. However, when infants under 12 months of age do become infected, the data suggest they are at higher risk for severe illness compared to older children.

Is the Coronavirus Dangerous For Kids?

Many respiratory-based illnesses, such as the flu, are concerning for the oldest and youngest among us. While COVID-19 is a big worry for the elderly, it’s uncertain exactly how it affects toddlers, preschoolers, and school-age children, who make up 22% of the infected population in the U.S., according to the CDC.

Researchers currently believe that while COVID-19 symptoms may be less serious among some kids, children may also experience the virus differently than the adult population, and be affected in ways we still are learning about. The most troubling trend is the rise in cases of Multisystem Inflammatory Sydrome in Children, or MIS-C, with 95 cases reported in New York as of May 10, including several deaths. MISC-C causes severe inflammation in the lungs and abdomen, with some children experiencing blood clotting and heart failure, too, according to a report in the journal Radiology. Symptoms vary and may take weeks—or potentially longer; no one yet knows—to show up. And while many of the hospitalized children tested negative for an active COVID-19 infection, they did test positive for antibodies. Fortunately, readily available corticosteroids can usually successfully treat most inflammatory symptoms of MIS-C.

It's also possible that children can get the virus and become vectors, or transmitters of the disease, especially to people at high risk, including their grandparents and older relatives.

Case in point: A large new study from South Korea documents that while children under 10 tend to spread the disease at lower rates than adults, the same is not true for tweens and teens between 10 and 19, who transmit the virus at least as well as their parents, teachers, and other grownups do (even when the kids remain asymptomatic themselves). Another report in JAMA Pediatrics shares that while up to 40% of all those infected show no symptoms, asymptomatic children can shed virus, or potentially be contagious, for up to 21 days.

It’s important to note: As with adults, children who have underlying health conditions (we’ll talk about this in the section below) might be at increased risk, and the same precautions against germs are key for all kids—and all, well, everyone—to prevent infection.

How Does the Coronavirus Impact People With Chronic Health Conditions?

In America, 60% of people wrestle with at least one chronic health condition—it's no small gang. Unfortunately, this puts you at higher risk of serious complications from the coronavirus. In one study based on Wuhan data, researchers found that people with COVID-19 who also had at least one additional medical condition—such as heart disease or diabetes—had a 79% greater chance of needing intensive care or a respirator (or both) to recover, or of dying. About 1 out of every 5 people who gets COVID-19 becomes seriously ill and might need to be hospitalized.

We know how scary this is. That’s why it’s so important to be informed and to practice preventative safety measures (which we’ll get into soon).

Per the Wuhan data, people at higher risk for serious complications from COVID-19 include those who have:

  • Diabetes. Some 30.3 million Americans, or 9.4% of the population, have this condition. The American Diabetes Association is offering tools to keep yourself safe during this pandemic if you have diabetes. Which is important, in light of statistics. According to the Chinese Center for Disease Control, in Wuhan the fatality rate was 7.3% for people with diabetes. With diabetes, it’s tougher to fight any infection, and circulation issues can lead to organ issues, making it harder for you to heal when hit with something like this illness.

  • Hypertension. Experts are still trying to figure out why this patient population was at risk in Wuhan, where the death rate for hypertensive patients was 6%. An estimated 103 million Americans have high blood pressure, according to the American Heart Association (AHA), which is providing precautions for heart disease patients and others.

  • Cardiovascular disease. The death rate for people in Wuhan with heart health issues and COVID-19: a staggering 10.5%. Info hasn't yet been published about who exactly in this group is at risk, but here are a few of the cardiovascular disease types that might be impacted, courtesy of the WHO:

    • Previous heart attack history

    • Cerebrovascular disease

    • Peripheral arterial disease

    • Rheumatic heart disease

    • Congenital heart disease

    • Deep vein thrombosis and pulmonary embolism

  • Chronic respiratory diseases. A stat on just one of these: The fatality rate for people with chronic obstructive pulmonary disease (COPD) in Wuhan was 6%. Asthma is another at-risk population, because lung capacity is already compromised. If you have asthma, call your doctor and discuss whether you need an extra inhaler on hand in case you end up with COVID-19.

  • Chronic autoimmune illnesses. Those that involve the lungs can run the risk of more serious cases of COVID-19. These include:

    • Scleroderma

    • Interstitial lung disease

    • Lupus

    • Pulmonary hypertension

  • Medically weakened immune systems. Are you a cancer patient on immunosuppressive drugs, like some forms of chemotherapy? Or taking a biologic medication for Crohn’s disease or rheumatoid arthritis? You’re also at higher risk for COVID-19.

  • Others who are immunocompromised. According to the CDC, this could include people: who've had bone marrow or organ transplantations; who have immune deficiencies or poorly controlled HIV or AIDS; who are on kidney dialysis; or who have prolonged use of corticosteroids or other immune-weakening medications. (Talk to your doctor if you’re concerned about your condition and medication.)

  • People who smoke or vape. Smoking—whether it’s tobacco, marijuana, e-cigarettes, or vaping—can damage your lung’s natural defenses, making them more susceptible to respiratory illnesses like COVID-19, according to the Mayo Clinic. Long-term smoking compromises lung function and can cause lung disease.

    So much is still unknown about COVID-19 and the risks of underlying medical issues, so we’re not sure if this applies just to current smokers or past smokers too, but the good news is that your lungs begin to heal as fast as a month after you stop smoking. Now is the time to pursue cessation programs to help your lungs start that process.

  • People who are obese. The CDC's at-risk guidelines include people of any age with severe obesity, or a body mass index of 40 or greater. More concerning, the CDC says that severe obesity is linked to severe COVID. Why? According to a small study published in Nature Reviews Endocrinology, it may have to do with respiratory dysfunction. Because obese people are more likely to have weaker respiratory muscles, lower lung volumes, and more airway resistance, it's harder for them to fight off the respiratory distress brought on by COVID, which ups their chances of developing pneumonia.

    Obese people are at additional risk if they have diabetes, renal failure, or liver disease, especially if uncontrolled.

Even if you aren’t in a high-risk group for the virus, it’s still better not to have it. Clinicians conducted a 15-year prospective cohort study examining patients who had the first SARS virus, finding long-term bone and lung issues, which could very well be an issue with COVID-19, too. Preliminary data from Wuhan and Hong Kong appears to show potential long-term effects of the disease, too, with diminished lung capacity for some COVID-19 patients.

Are There Other People at High Risk for COVID-19?

Beyond age or pre-existing medical conditions, there are three additional things, per the CDC, that can elevate your risk of exposure:

  • Community spread: This means if you live in or just visited a place where lots of people have tested positive for the illness.

  • Being a healthcare worker: Medical professionals put themselves in harm’s way during infectious epidemics to care for the sick—it’s no different with COVID-19. This includes doctors, nurses, and anyone else working in hospitals, ERs, nursing homes, long-term care facilities, clinics, and other places with coronavirus patients.

  • Close contact: In other words, people who are taking care of someone or live in the same house as someone who's tested positive for COVID-19

What Should I Do if I Have the Coronavirus? (Or Suspect I Do?)

Say you meet the above criteria. What to do next? These three steps can help.

  1. Calm yourself (as much as you can). As we’ve mentioned, about 80% of cases turn out just fine, without special treatment needed. And in those 20% of cases that are more serious, you can get better.

  2. Don’t rush out. Before you speed off to your doctor’s office or the local emergency room, stop. If you do have COVID, you could transmit it to others. We know this might be tough when you're scared and feeling badly, but consider your own health, too: You don’t want to expose yourself to other illness if you’re already sick with something.

  3. Call your healthcare professional, asking your doctor’s office, urgent care clinic, or emergency room what you should do in light of your symptoms and recent travel/exposure to the illness. Another place you might be directed to: your local health department; they’re helping with testing. The National Association of County and City Health Officials has a handy directory of local health departments, by state, that can lead you to the right person to speak to about finding out if your symptoms are COVID-19 or the flu or a cold.

How Do You Get Tested and Diagnosed with COVID-19?

Testing got off to a bumpy start in the U.S., when the CDC had an initial issue with their test kits. Then, it took time to roll out more tests across the U.S., and there have been delays across the country as healthcare professionals haven’t received tests or haven’t received enough tests. There are also delays in receiving test results because of a backlog of cases being processed in overwhelmed labs.

Depending on where you live, the severity of your symptoms, and your background (age, high-risk group, etc.), at this point you may not even be given a test. This is evolving as more tests are becoming available in the U.S., helped by research and testing capabilities from universities and private companies. Check out HealthCentral’s piece about COVID-19 hotline numbers state-by-state.

How Does Coronavirus Testing Work?

If you get a test outside of the hospital, you’ll likely receive a nasal swab (called a nasopharyngeal swab by the pros). For this one, the tester takes a sample from your nose using a special swab. You might’ve had this done for the flu. It can be unpleasant because it feels like the wire-like swab goes deep into your nose.

If you end up at the hospital without having been tested first, healthcare professionals might use a different method of testing. They’ll decide which test is best based on your abilities (if you’re unconscious, for instance, any test that requires your assistance, like coughing into a cup, isn’t possible) and their preferences. The testing options include:

  • Nasal aspirate. Your health care provider injects a saline solution into your nose. Then, they remove the sample with gentle suction. This might feel a little funny as it happens.

  • Tracheal aspirate. This one features a thin, lighted tube (called a bronchoscope) that’s put down your mouth and into your lungs for a sample to be collected there. There could be some discomfort with this test.

  • Sputum test. You cough into a cup for this test, releasing sputum, a thick mucus coughed up from your lungs. Easy enough, right? Or they might use a special swab to take a sample of mucus from your nose if you can’t cough anything up.

  • Blood. Known as a rapid serum antibody testing for IgM and IgG, this is done using a finger prick and results take about 10 min.

If you suspect you have COVID-19 and can find a surgical mask, it is advisable to wear one too see your doctor. More, however, on generally reserving surgical masks for healthcare pros and other essential workers below.

One country that has done well with testing and diagnosis: South Korea. Officials quickly set up drive-through testing sites there, where people could drive up, be effectively tested, and then drive away, reducing the risk of exposure to health care professionals.

That’s becoming the norm in the U.S., too, as areas in Washington, California, New Jersey, and New York add drive-through testing sites to more quickly offer testing services while protecting testers.

Who Gets Tested for COVID-19?

Because there currently aren't enough tests for everyone—or even those with symptoms—there's a first-second-third when it comes to testing. As of March 24, 2020, this was the CDC's who-gets-tested priorities:

Priority 1:

  • Hospitalized patients

  • Symptomatic healthcare workers

Priority 2:

  • Patients in long-term care facilities with symptoms

  • Patients 65 and older with symptoms

  • Patients with underlying conditions and symptoms

  • First responders with symptoms

Priority 3:

  • Critical infrastructure workers with symptoms

  • Individuals who do not meet any of the above categories but have symptoms

  • Healthcare workers and first responders

  • Individuals with mild symptoms in communities experiencing high COVID-19 hospitalizations

Non-priority:

  • Individuals without symptoms

If you've been in touch with your healthcare professional and can't get a test but have COVID-19 symptoms, have traveled to an area where there’s been documented community spread (like China, Italy, France, Spain, South Korea, and—in the U.S.—New York City, Seattle, and on), or been in contact with someone who has tested positive for the novel coronavirus, the CDC says to stay home and not leave the house for at least 10 days from the onset of symptoms.

How Long Do I Need to Isolate?

So, you’ve tested positive for COVID-19. Hopefully your disease remains mild and doesn’t require any expert intervention. Here’s what to do now to protect other people: If you have mild or no symptoms, isolate for 10 days after you test positive for viral RNA and/or begin having symptoms. Those with more severe symptoms should isolate for 20 days following a positive test. The reason? By this point in your illness, the virus is longer able to replicate—and therefore infect—other people.

Early in the pandemic, doctors required a test-based strategy to discharge a COVID-19 patient from the hospital–if you tested negative twice within a 24-hour period, you’d be free to leave. As of July 17, these guidelines have been updated based on research that shows a person is most contagious early on in their COVID-19 illness progression.

Here’s what hasn’t changed: You must still isolate for 14 days after an exposure to someone who has COVID-19. If you never develop symptoms nor test positive within these two weeks, you’re in the clear. However, say you start feeling sick and/or test positive Day 11 of this initial quarantine period. You must now isolate for an additional 10 to 20 days based on your symptom severity. So yeah, you could be in isolation for as long as five weeks if your infection is severe.

What’s the Treatment for the New Coronavirus?

Thus far, there’s no specific treatment for COVID-19. We can’t use antibiotics to treat the virus itself, because they’re for bacterial infections—there’s nothing in a virus that an antibiotic can target and attack. What’s needed is an antiviral. But currently there’s no antiviral specifically for this new disease.

Along with creating and testing a vaccine—which, realistically, might not be widely available until mid-2021—companies and scientists are racing to develop, or find, a drug that could help. WHO officials launched the SOLIDARITY trial on March 23, 2020, a worldwide study aiming to uncover the best treatment, fast, for COVID-19.

Researchers and healthcare professionals in the field first investigated hydroxychloroquine sulfate, which was quickly determined to potentially cause serious side effects without providing promising results, as well as chloroquine phosphate, another medication originally developed to treat malaria but now commonly used to treat lupus. So far, it hasn't shown much efficacy, either.

Other therapies include remdesivir (approved by the FDA for emergency use for COVID-19 infections after it showed it could help shorten hospital recovery times), two HIV drugs (Ritonavir and lopinavir, currently not showing any benefit), and the use of convalescent plasma from COVID-19 patients who have recovered (which has been shown in various studies to quicken recovery among the seriously ill and decrease mortality rates).

In June, UK researchers announced the welcome results of a major clinical trial: Dexamethasone, a cheap, widely available corticosteroid, significantly reduced mortality among severely ill people with COVID-19 by an astonishing one-third in patients who were already on ventilators, and by one-fifth among patients who'd been given supplemental oxygen. However, for those who were not sick enough to require respiratory support, no benefit (and even some harm) from the drug was reported. It appears timing this treatment to the right stage of the disease may be key.

And, as we learned in early October when the president tested positive for COVID-19 and was treated at Walter Reed National Military Medical Center, experimental new therapies are in the works. This includes monoclonal antibodies, which are synthetic versions of the antibodies our immune sytems use to ward off disease. (This treatment is not yet available to the public.)

So what happens if you’ve got COVID-19 now? If your symptoms have just cropped up and are mild at the start and continue that way, here’s what you should do:

  • Let your doctor know what’s happening, and speak to her by phone regularly, especially if your symptoms worsen, you are concerned, or you’re at high risk for negative outcomes with COVID-19.

  • Isolate yourself from others for 10 days after symptom onset, as long as your disease remains mild to moderate. If your COVID-19 symptoms become more severe, the CDC advises a 20-day isolation period to ensure you do not infect others.

  • Drink plenty of fluids to help your body maintain its overall health.

  • Rest. Rest. Rest. Did we mention you should rest?

  • Take over-the-counter pain meds, like acetaminophen (Tylenol) to combat the fever, joint pain, and headaches. There’s been controversary over the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), after French doctors observed worsening conditions in patients taking them with COVID-19.

    This is still anecdotal, meaning it hasn’t yet been investigated fully in a study, and WHO officials have said that it’s not yet clear if NSAIDs pose a substantial risk to all COVID-19 patients. But maybe stick to Tylenol for now.

  • If possible, eat healthily, focusing on anti-inflammatory foods, like frozen fruits, vegetables, green leafy things; and take your normal medicine and multivitamin. You need to keep your body as robust as possible to fight this virus, and research has shown that a healthy diet can have a positive effect on overall wellbeing.

  • Practice self-care. If you’re strong enough, meditate: It’s been shown to have many health benefits, including reduced blood pressure and decreased oxygen utilization. Many apps, including Calm and Headspace (which is offering some of its services free to people, including teachers and healthcare professionals), can help you with this.

  • Don’t drink alcohol. It can tamp down your body’s ability to fight infection.

You’ll likely do these things at home to help prevent overcrowding of hospitals if your case is mild or moderate. For many people, the symptoms eventually subside, and you get better without treatment. It can take time—up to two to three weeks to feel better.

When should you seek more medical help? And how should you do so?

Contact your healthcare provider or emergency room immediately if you have severe symptoms:

  • Persistent pain

  • Pressure in the chest

  • New confusion or an inability to arouse

  • Bluish lips or face

  • A blood-oxygen reading (from a pulse oximeter) of 92% or below

This sounds morbid, but it’s need-to-know: In Wuhan, those who ended up dying of the coronavirus had severe trouble breathing. If you start to show symptoms of pneumonia—which include worsening cough, increased trouble breathing, and high fever (103-104 and above)—call 911 and tell them that you have, or are being evaluated for, COVID-19.

However—and this is important—many ER docs across the U.S. have reported examining a high number of seriously ill COVID-19 patients who they describe as being "happy hypoxics," meaning those admitted were not complaining of severe shortness of breath, dizziness, or confusion, even when their blood-oxygen levels were dangerously—sometimes, even life-threateningly—low. So, if you are sick at home with this virus, be sure to regularly check your own blood-oxygen levels with a pulse oximeter, which you can purchase online or from any drugstore. A normal reading is 94% to 100%. A reading of 85% is dangerously low so don't wait—get to the ER. Anything under the 92% range is worth a call to your doctor. (But take a few consecutive readings first to make sure you've got an accurate reading.)

If you have a paper facemask, put it on before emergency medical services arrive to help reduce the risk of spreading the disease, as much as you can, for the emergency responders. At the hospital, you could be given oxygen or put on a ventilator depending on how intense your case is.

How Can I Prevent Getting COVID-19?

We’re not sure yet if having the virus once prevents you from getting it again: Experts say that past experience with coronaviruses suggests you’d develop an immunity to it, but that’s preliminary thinking that requires more research. And, there are several documented cases of people who tested positive, experienced symptoms, rebounded, tested negative (sometimes more than once), and then grew ill again, testing positive for a second time. (To date this is rare, but it has occurred.) Right now, especially with a lack of real treatment, protecting yourself and your loved ones is critical.

First off, practice social distancing! Quarantining Wuhan, China, has finally brought the number of cases down, so this strategy—staying home and in physical contact with as few people as possible—does help flatten the curve.

Then follow these tips for coronavirus prevention:

  • Wear a face mask whenever you are within 6 feet of others (outside of your quarantined household) and cannot maintain social distancing.

  • Avoid gathering in groups indoors, especially in poorly ventilated spaces.

  • Wash your hands—often!

  • Use hand sanitizer, with at least 60% alcohol, when you don’t have access to soap and water.

  • Avoid touching your face, especially your eyes, nose, and mouth.

  • Work from home, if you can; definitely stay home when sick.

  • Cough and sneeze into a tissue or, at the very least, your elbow.

  • Regularly disinfect high-touch surfaces—doorknobs, faucets, cell phones—with sanitizing wipes, diluted household bleach (not for phones!), or EPA-registered household disinfectants.

  • Kill COVID-19 from soft surfaces in the washing machine—laundry detergent does the trick.

  • Skip the handshake; elbow-bump or air high-five.

  • Use your knuckle or elbow for doorbells and elevator buttons.

  • Pay with credit card or Apple Pay instead of cash, if you can. Ideally, you should then run a sanitizing wipe over your CC.

  • Rely on paper towels for public faucets, door handles, gas pumps, and that pen you've gotta touch when signing a credit card receipt.

  • Stock up on nonperishable goods—but don’t clean the store out of toilet paper! Leave some for others.

So How Do You Wash Your Hands Properly?

With so much talk of handwashing, a quick review might be in order (we know, you’ve been doing it since preschool, but nevertheless). Basically, you should wash your hands:

  • Before, during, and after handling food

  • Before eating After using the bathroom

  • After blowing your nose, coughing, or sneezing

  • After touching high-touch surfaces or handling anything others have touched

  • After being in public spaces

The drill: Run your hands under the faucet, then lather up for at least 20 seconds, making sure the soap gets between your digits, under your nails, and up to your wrist bones. Rinse and dry with a clean towel or air dryer. Done.

The key step, no surprise, is the soap. Here’s why: The novel coronavirus has an envelope around it made of lipids (fats), and it depends on this envelope for survival. Soap (as well as hand sanitizers with 60% and higher alcohol content), disrupts the envelope and thereby destroys the virus.

Do Masks Actually Help Prevent the Spread of COVID-19?

Wearing face masks helps reduce the spread of the virus through infected aerosolized droplets, especially from people who have COVID-19 but may not know it yet. How? Regular surgical masks and cloth face coverings help keep in check droplets from your sneezes, coughs, talking, singing, and exhaling, but may not offer much protection to you if you're exposed to smaller droplets that can make their way through more porous mask materials, or get into the sides of any mask. (That's why it's so important everyone get on board and wear one to protect their loved ones, friends, coworkers, neighbors, and, yes, even strangers.) Also: Standard face masks obviously don't cover or protect your eyes from exposure.

Medical-grade N95 and K95 face masks, on the other hand, which were in short supply at the beginning of the pandemic and are now more easily available for purchase online, do offer the wearer protection, filtering out at least 95% of viral particles that may be found in the air.

At the beginning of the pandemic, the CDC wanted to save those precious N95 and K95 masks for essential health care workers on the frontlines. Now, the agency recommends that everyone wear a face mask or cloth face covering when venturing out in public settings where social distancing measures are difficult to maintain (for example, when you’re standing on a long line at the grocery store or pharmacy). This is especially important to do in so-called “hot zones,” the regions of the country with the highest rates of community spread of COVID-19, and in indoor spaces with poor air quality where groups of people gather. (Note: Masks should never be placed on young children under age 2, or on anyone who has trouble breathing, is unconscious or incapacitated, or is otherwise unable to remove the mask without assistance.)

What fabric should you choose to make a DIY face mask? The idea is to use cloth that is not super porous. T-shirts and bandanas are more porous than high-thread-count bedsheets, so literally cutting up those sheets is a good (if not perfect) option.

Finally, an important note on masks with valves—you know, the kind used on construction sites to prevent workers from breathing in dust particles. This type of mask is not ideal in the fight against COVID-19. While they do filter the air you're inhaling, they don't filter the air you're breathing out. And the main reason we all wear masks is to protect other people from our own exhaled respiratory droplets. The CDC even states that masks with valves should "not be used where a sterile field must be maintained" (such as an operating room) because of risk of air contamination. You're better to skip this type of mask and opt for a homemade cloth face covering, or simply use disposable surgical masks, which are now much easier to find for purchase online.

Are There Additional Protective Measures If I’m High-Risk?

If you’re over 60 or in one of the other high-risk groups, you might already know about prevention techniques because flu season poses a real worry for you already. You use social distancing, have a great supply of hand sanitizer, and know what it means to stay in for the duration.

You’re also done with hearing that “for most people” this illness might have mild symptoms—you’re not most people, and your health and well-being matters just as much as it does for the other 80% who don't experience serious illness. (It must be noted that COVID-19 "long-haulers" might not agree with that well-touted ratio, or the general assessment of what determines a serious case of this disease.) For you, avoiding COVID-19 is of paramount important. If you’re at high risk for getting very sick, the CDC now recommends doing the following:

  • Take everyday precautions to keep space between yourself and others.

  • Avoid indoor spaces with poor or limited air circulation.

  • In public, keep away from anyone who is sick, limit close contact, and wash your hands often.

  • Stick with the smallest group of people that you can—if you live with someone, live with them and only them. Avoid crowds of 10 or more (true for everyone, actually), or even small gatherings (think, a dinner party with extended family), because flattening that curve means keeping your exposure to others as minimal as possible.

  • Avoid cruise travel and non-essential air travel.

  • If there’s a COVID-19 outbreak in your community, stay inside as much as possible.

If you are in one of these groups, here are more things to do:

  • Talk to your doctor about your risks and how best to minimize them. Maybe not with an in-person doctor’s appointment, which could expose you to germs—instead, ask if your doctor can do a phone consultation. Or email your doc through your patient portal system if possible.

    As more of the U.S. turned to shelter-in-place and cities shut down, telemedicine became necessary for people to receive medical care. Rules that once made this tough have rapidly changed. To address these needs, in March 2020 federal privacy regulations were relaxed by the Health and Human Services (HHS) Office for Civil Rights (OCR), and Medicare expanded payment policies. The FDA issued guidance, only to be used during the pandemic, to allow more at-home monitoring of health measurements formerly only taken in a doctor’s office, including home blood pressure readings and home electrocardiography.

  • Ask about wearing a surgical mask or N-95 respirator outdoors. If you have a chronic condition and need to travel or visit the grocery store or bank, for instance, discuss with your doctor whether you should wear a surgical mask or respirator.

  • Get the flu and pneumonia vaccines. Even now. Especially if you’re over 60, or if you’re prone to pneumonia. Call your primary care doctor and discuss if this is a good option for you, and if you can have one at a pharmacy, your doctor’s office, urgent care, or some other safe location.

  • If you do need to go out, avoid high-traffic times. Go to the post office when it’s off-hours (think mid-day). Do your food shopping when the store opens, or late at night before it closes. Visit a local restaurant to pick up dinner at 3:30 p.m.

  • Make sure to care for your mental health. This is a challenging time for all, but it’s especially difficult if you’re at major risk of negative outcomes with this virus. Try and schedule video calls with friends and family so you can see, not just hear, them. Set up a call with a therapist. And if you’re feeling deeply lonely or suicidal, call the National Suicide Prevention Lifeline: 800-273-8255. They have a chat line, too: suicidepreventionlifeline.org/chat.

What Are the Differences Between COVID-19 and the Flu?

It’s mind-boggling trying to self-diagnose when COVID-19's symptoms are so similar to the flu, a cold, or even seasonal allergies. But we can’t say this enough (and if the president or any TV pundit says it, they’re wrong): COVID-19 is not the flu. For these reasons:

  • More rapid spread: COVID-19 has been spreading more widely than the flu. How rapidly a disease spreads, or is transmitted, is measured with something called a reproductive number, called Ro (pronounced R-nought or r-zero). The Ro is how many people one infected person will transmit the disease to. For COVID-19? It appears to be between 1.4 and 2.5 people per person, according to the WHO. For the flu? It’s 1.3 people for every one person.

  • No immunity to stop it: The flu has been around for years—the first influenza pandemic was in 1580—and while flu strains mutate (which changes the flu’s viral structure, thus leaving more people at risk of catching it), COVID-19 is a brand-new virus. We are what’s called a virgin population to it, meaning we have no herd immunity (when enough people have an illness or receive a vaccine against it, they develop antibodies to it so they don’t all catch and spread it at once). Globally, everyone on earth could get COVID-19, all 7.5 billion of us—which isn’t true of the flu, because if you’ve had some strains of the flu, even years ago, you have antibodies/immunity to it—even if you’re exposed to it again, you won’t likely catch it.

  • No vaccination to prevent it: We have yearly vaccinations to stop the newly mutated strains of the flu (since 1945!) but none for COVID-19.

  • No medications (yet) to treat it: We have four U.S. Food and Drug Administration (FDA) approved antiviral medications, like Tamiflu, to treat the flu. COVID-19 is so new, we have no specific therapy to treat it yet, though companies are racing to find a cure, medication or otherwise. So if you get it, you’re older than 60 and/or have any of a long list of medical conditions (see more later on), you have no treatment options until the disease has worsened to pneumonia—and then the treatment is essentially to stabilize your worsening condition.

  • Mortality rates are higher: There have been some 20,000 deaths this year alone from the flu. You might hear people say, well, more people have died from the flu this year than COVID-19. Which, up until late March, was true. We’re also not at the peak of the new coronavirus, nor do we know if it will be a seasonable disease, meaning that it strikes during the fall/winter and eases during the summer. The flu season typically begins in October or November and ends in May each year in the U.S. Meanwhile, right now, it’s estimated that about 1% to 3.4% of people with COVID-19 are dying, and we don't know when this pandemic will ease. The mortality rate for the flu? Fewer than 1%. COVID-19 appears to be 10 times deadlier than influenza, but that number is still up in the air, as we’re unsure how many people with COVID-19 have mild symptoms and haven’t tested positive. Good news on that front though: A test that finds antibodies, meaning you’ve had COVID-19 already, could be released soon, so we’ll know just how people had it, possibly pushing the mortality rate down.

The flu is actually the main point of reference for comparing one serious virus to another. In particular, the 1918 influenza, one of the deadliest pandemics in modern history. Caused by the H1NI flu virus, that disease struck an estimated 500 million people across the globe, killing an estimated 50 to 100 million people (675,000 of those were Americans) in a matter of months.

The differences between the 1918 influenza outbreak and COVID-19 are significant. Back in 1918, health authorities had no idea what was happening beyond that it was a bad flu—it wasn’t until 1933, 15 years later, that scientists even knew a virus caused the human wreckage.

With COVID-19, scientists in China had identified the sickness sweeping Wuhan as a coronavirus, sequenced its genome to better help find an effective treatment, and pinpointed bats as the likely animal hosts, within two weeks of the virus first appearing. To read more about how COVID-19 compares to other pandemics—such as Ebola, bird flu, and SARS—check out our story.

Erin L. Boyle
Meet Our Writer
Erin L. Boyle

Erin L. Boyle, the senior editor at HealthCentral from 2016-2018, is an award-winning freelance medical writer and editor with more than 15 years’ experience. She’s traveled the world for a decade to bring the latest in medical research to doctors. Health writing is also personal for her: she has several autoimmune diseases and migraines with aura, which she writes about for HealthCentral. Learn more about her at erinlynnboyle.com. Follow her on Twitter @ErinLBoyle.