Coronavirus: Expert Provides a Guide to Common Questions

This virus, which originated in China and is causing illness across the globe, is a member of the virus family Coronaviridae. Most viruses in that family come from animals, including camels, cattle, cats and bats. Coronaviruses infecting animals can evolve and gain the ability to cause human disease. People around the world commonly become infected with human coronaviruses, experiencing a mild respiratory infection in most cases. With the SARS-CoV outbreak of 2002 and 2003, for the first time, we saw a new coronavirus that could spread between people and caused a severe acute respiratory illness and also some deaths. Again, in 2012, another new coronavirus called MERS-CoV emerged causing serious illness in humans.

This virus, named SARS-CoV-2, causing the disease called COVID-19, is different from SARS and MERS in key ways, however, all most likely originated from bats, mingled with animal coronaviruses and gained the ability to transmit to humans, though extensive research is needed to confirm its origin.

Many of the early identified patients in Wuhan, China had some link to a particular seafood and live animal market, suggesting that is where the infection may have originated. As the number of cases grew, however, patients reported no exposure to that market, indicating that person-to-person spread was occurring.

As with other respiratory viruses, such as influenza for instance, this person-to-person spread happens via respiratory droplets produced when an infected person sneezes or coughs. The droplets can land in the noses and mouths of people nearby or be inhaled, leading to infection. Many respiratory viruses also spread by fomite exposure (an object carrying the infectious agent) when someone touches a surface with the virus on it, then touches their mouth, nose or eyes without washing their hands. A recent report from the Chinese CDC (China CDC Weekly, 2020, 2(8): 123-124) indicates a potential fecal-oral route for spread as well. This may be an additional way COVID-19 is spreading though more research is needed to confirm.

With most respiratory viruses, people are the most contagious when they have the most symptoms, however, there are reports of spread to a close contact from someone showing no symptoms.

Ultimately, this is a new disease and we are still learning exactly how it spreads and the full extent of the illness it causes.

This virus is hard to contain because it is new to humans, meaning we don’t have pre-existing immunity for it. In addition, unlike for the flu, there is no vaccine for it. This leaves a huge number of people potentially susceptible to infection and spreading the virus. Ultimately, this makes it more difficult for vulnerable members of the population to protect themselves.

Reported symptoms in people confirmed to be infected with COVID-19 range from none (asymptomatic) to typical (fever, cough, shortness of breath) to severe (atypical pneumonia along with fever and in severe cases, a patient may develop organ failure and die). Based on data gathered so far, symptoms may appear as soon as two days or as long as 14 days after exposure.

In terms of treatment, antibiotics don’t work because this is a virus not a bacteria causing the disease. There is no specific treatment for this disease. People who are infected would receive supportive care for their symptoms and organs as necessary.

Although the spread of this virus is concerning, we shouldn’t panic. The CDC and local health departments are aggressively working to limit the transmission through keeping us informed of the latest information.

The CDC has outlined the following risk assessment:

• For most of the American public, who are unlikely to be exposed to this virus at this time, the immediate health risk from COVID-19 is considered low.
• People in communities where ongoing community spread with the virus that causes COVID-19 has been reported are at elevated, though still relatively low risk of exposure.
• Healthcare workers caring for patients with COVID-19 are at elevated risk of exposure.
• Close contact of people with COVID-19 are at elevated risk of exposure.
• Travelers returning from affected international locations where community spread is occurring are at elevated risk of exposure.

The same general advice on how to prevent spreading respiratory viruses applies. Frequent thorough handwashing using soap and water for at least 20 seconds, especially after going to the bathroom, blowing your nose, coughing or sneezing and before preparing or eating food, is advised. Use hand sanitizer with at least 60 percent alcohol if soap and water aren’t available. Avoid touching your mouth, nose and eyes. Frequently clean and disinfect surfaces that might be contaminated. Avoid close contact with other people if you are unwell or they are sick.

A lot of people are dying from this virus.

This is not true. While it is tragic when even one person loses their life to disease, we are looking at an approximate death rate of 3.4% (WHO, 3.4.2020) of reported cases of COVID-19, meaning 96.6% of all patients survive this infection worldwide. Ebola, by contrast, has a case fatality rate of approximately 50%. Influenza has an annual death rate of 0.01%. As of the morning of March 5, 2020, the US death toll is at 10.

Every person who is coughing or has a fever is infected with coronavirus.

This is not true. We are in the thick of flu season, other respiratory pathogens are circulating, this is wintertime, and most of us haven’t traveled to locations with confirmed COVID-19 cases or been around people who have.

Unfortunately, people most at risk for severe illness due to COVID-19 are the elderly, as well as people with cardiovascular disease, diabetes, chronic respiratory illness, high blood pressure and cancer due to being immune-compromised because of their treatment. What this means is that a cancer patient (and people in the other groups listed) needs to take precautions to prevent getting infected with COVID-19 in the first place. This happens in the same way you would for any respiratory disease: frequent hand washing with soap and water for 20 seconds and avoiding touching face (eyes, mouth and nose) with unwashed hands. If soap and water aren't available, using hand sanitizer with at least 60 percent alcohol is okay.

Elderberry has been studied for its antiviral and antimicrobial effects and what several small studies show is that it does have an ability to help reduce the severity and duration of symptoms caused by the common cold and influenza infection, however, more studies are needed. As far as studies with coronaviruses, we don't have data showing that elderberry is effective against this virus. You can boost your immune system by getting plenty of rest, minimizing stress and eating a balanced diet rich with foods that are full of vitamins C, E, A, D and minerals such as zinc, to name a few. Mega doses of vitamin C haven't been shown to significantly reduce the incidence of colds and haven't been studied for coronaviruses.

The CDC has a great interactive map that will help travelers keep up to date on developments and travel restrictions related to COVID-19 globally. The situation is rapidly evolving so travelers should check back frequently to help guide decisions. In addition to travel notices, there is specific information on air and cruise travel as well.

Symptoms may appear two to 14 days after exposure and currently data is limited on how long COVID-19 disease lasts in the majority of people (those who experience minimal to mild symptoms). Other human coronaviruses typically run their course in under a week in mild cases. In the severe cases that require hospitalization, studies on COVID-19 cases report that hospitalization occurs on average nine to 12 days after the onset of illness.

Currently, there is no evidence showing that COVID-19 can be transmitted in association with food. As always for food safety, it is important to wash your hands with soap and water for 20 seconds both before preparing or eating food. In addition, the risk of transmission from food products or packaging that are shipped over days or weeks at room temperature, in refrigeration, or at frozen temperatures is very low. In short, getting the virus from food at restaurants is highly unlikely.

So far, studies suggest that the virus that causes COVID-19 is mainly transmitted through contact with respiratory droplets rather than through the air. These small droplets come from the nose or mouth and are spread when an infected person coughs or exhales. They land on objects and surfaces within six feet and other people who then touch these surfaces and then their mouths, nose or eyes without washing their hands can become infected. Also, these droplets can be inhaled by people around the infected person, leading to infection. This is how respiratory infections are typically transmitted.

Currently, there are no FDA-approved treatments for COVID-19. Treatment involves supportive care (treating symptoms) such as the fever, cough and other complications, including advanced organ support for individuals with severe disease.

Symptoms may appear two to 14 days after exposure with many people reporting symptoms on average five days after exposure.

A study published recently in the Journal of the American Medical Association (doi:10.1001/jama.2020.2783) reported that among four COVID-19 patients treated in Wuhan, China, who all recovered and tested negative for the virus after recovery, all later tested positive five to 13 days after they were considered virus-free. With this and several additional similar reports, what we know is that either some patients are not developing a lasting immunity and are being re-infected or they are not completely clearing the virus although their symptoms are going away. Until more study is done, it's difficult to say for sure which is correct.

So much is still unknown about COVID-19. This is an ongoing outbreak that is rapidly evolving. The WHO has said there is a “window of opportunity” to curtail the spread of this disease and the worldwide health and science communities are collaboratively working on learning more about how transmissible it is from human-to-human, the characteristics of an individual who becomes severely ill and is hospitalized, and on vaccine development, among many other factors. Up-to-date information should be sought from reputable sources listed below, along with your local health department.