COVID-19 in 20 Questions

COVID-19 (coronavirus disease 2019) is a respiratory infection first identified in Wuhan, China, in December 2019. It is caused by a novel type of coronavirus named SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). Viruses and the diseases they cause often have different names.

Coronaviruses are a large family of viruses so named because proteins studded across their surface stick up like the points on a crown. These spikes assist the virus in binding to cells in order to gain entry. They are zoonotic, which means they can sometimes be transmitted between animals and people. A genetic analysis in January 2020 of SARS-CoV-2 suggests that it may have passed through one or more species of animals before being transmitted to humans.

Coronaviruses usually lead to mild upper respiratory infections, such as the common cold. However, three times in the last 18 years, coronavirus outbreaks have caused serious disease across the world: SARS (severe acute respiratory syndrome) in 2002, MERS (Middle East respiratory syndrome) in 2012, and now COVID-19.

The seasonal flu is caused by any of a number of types and strains of the influenza virus, an altogether different family of viruses. The World Health Organization lists the similarities and differences between COVID-19 and influenza. Unlike COVID-19, influenza has been studied by scientists for decades, and a great deal is known about symptoms, risk of infection, and ways to treat seasonal flu.

In January 2020, researchers published the first sequence of the viral genome responsible for COVID-19. Within a week, the sequence information was used to develop a test to detect the presence of the virus. Additional genomic studies showed that the virus was similar to but distinct from the viruses responsible for SARS and MERS. Sequences from several of the earliest patients in China were nearly identical, suggesting that the virus had only recently entered the human population. As the virus has spread, certain strains have acquired genetic changes. By sequencing the virus of different patients, these genetic changes can be compiled into a viral “family tree” and used to track disease transmission. Other researchers have used the genetic sequence to identify ideal targets for vaccine development.

The Centers for Disease Control and Prevention notes that the virus primarily spreads from person to person through small drops of liquid called respiratory droplets. These are produced when an infected person coughs or sneezes. People must generally be within six feet of someone who is contagious to encounter these droplets and become infected.

According to the World Health Organization, preliminary studies suggest that the virus may persist on hard and soft surfaces for a few hours or up to several days, depending on type of surface, temperature, humidity, etc.; research is ongoing. This means that the virus may possibly be spread when someone touches a surface or object with the virus on it and then touches their own mouth, nose, or eyes.

The Centers for Disease Control and Prevention reports that the period of infectiousness for COVID-19 isn’t fully known. Some studies suggest that people who have contracted the coronavirus are “shedding” infectious viruses—and can therefore infect others—even before they develop symptoms. Scientists have also found that some individuals continue to shed the virus after they have recovered. However, it’s not known whether they are shedding intact infectious viruses or inactive fragments of the viral genome.

Most confirmed cases of COVID-19 have occurred in adults. Infections have been reported in children of all ages, but the data suggest that older adults (age 65 and above) are at higher risk for serious COVID-19 illness. The risk may be twice as high in these populations, possibly because immune systems change as people age, making it harder to defend against disease and infection. Individuals with a certain set of preexisting health conditions (persons with chronic lung disease, heart disease with complications, severe obesity, diabetes, hypertension, renal failure, or liver disease or those who are immunocompromised) are also at high risk for severe illness from COVID-19. Data released by the Centers for Disease Control and Prevention for March 2020, the first month of the WHO’s declaration of the pandemic, show that, of the people who were sick enough to be hospitalized, nearly 90% had at least one chronic condition. It is harder for the body to recover from illness when these underlying disorders are present.

Additional data suggest African Americans are disproportionately affected by COVID-19 and are more likely to be hospitalized or to die from the disease. Racial and ethnic demographic data are not always publicly reported, and there are gaps in this information from state to state. Regardless, the available data suggest that the increased frequency of infection and poorer outcomes are being driven by historical inequities in job opportunities, housing density, health risks, and access to health care.

All viruses mutate, acquiring changes in their genomes over time. This is a natural part of the life cycle of a virus. As of late March 2020, the SARS-CoV-2 genome has undergone very few mutations during its global spread. While these changes can be used to track patterns of infection, they do not appear to have made the virus more severe or more easily spread.

The best way to prevent COVID-19 is to avoid being infected. The Centers for Disease Control and Prevention has a list of guidelines to help minimize the spread of respiratory illness, which includes commonsense advice such as steering clear of close contact with individuals who are sick; not touching your eyes, nose, and mouth; and washing your hands often with soap and water for at least 20 seconds.

No. This idea and others have been touted on social media platforms as a way to prevent disease. None of them are effective—and some are actually dangerous. The World Health Organization has an article that exposes the myths behind many rumors about the cause, prevention, and treatment of COVID-19.

As of March 2020, face masks were not recommended for people who were well. In early April, however, the Centers for Disease Control and Prevention amended their recommendation and suggested that individuals wear cloth face coverings in public settings where social distancing is a challenge, such as grocery stores and pharmacies. The wearing of surgical masks and N95 respirators by the public is not recommended, in order to reserve them for use by health care professionals. Cloth face coverings should also be worn by individuals who are ill when they have to be around other people. If a sick person cannot wear one, cloth face coverings should be worn by the individuals who are caring for that person.

Accurate testing is critical to identifying and tracking the spread of COVID-19. There are two categories of testing: molecular and serological.

Molecular testing searches for the presence of SARS-CoV-2 genetic material, indicating active infection. A health care provider collects a specimen from the nose, throat, or lungs of an individual suspected of being infected. The sample is sent to a testing lab, where technicians extract the genetic information and search for sequences specific to the SARS-CoV-2 virus. Different technologies and approaches may be used. Though some tests provide results within minutes, most take several hours or more.

Serological testing seeks evidence that the body has generated an immune response to the SARS-CoV-2 virus. This indicates the individual has previously been infected and is either currently recovering or recovered some time ago. These tests generally search for the presence of antibodies associated with the virus and may also be able to quantify the amount of antibodies or even whether those antibodies can prevent the virus from entering cells. It is believed that the presence of antibodies to the virus indicates protection from being reinfected. Research with other forms of coronavirus suggests that this protection may last between several months and one or two years.

If you believe you have been exposed to COVID-19 and develop a fever and symptoms of respiratory illness, such as cough or difficulty breathing, call your health care provider immediately. The Centers for Disease Control and Prevention has published a set of guidelines for individuals who are sick with COVID-19 or suspect they are infected.

The current COVID-19 status can be found at both the Situation Dashboard from the World Health Organization and the COVID-19 GIS Dashboard developed by Johns Hopkins University’s Center for Systems Science and Engineering. Both include the numbers and geographic locations of cases as well as data on deaths and those who have recovered.

The Centers for Disease Control and Prevention lists nine common symptoms of COVID-19: fever, cough, shortness of breath or difficulty breathing, chills, repeated shaking with chills, muscle pain, headache, sore throat, and sudden loss of taste or smell. Symptoms may appear as quickly as 2 days or as long as 14 days after exposure. As with other respiratory conditions, the severity of COVID-19 varies among patients. An analysis published in February 2020 of nearly 45,000 confirmed patients in China found that 81 percent had mild symptoms and 14 percent were classified as severe (involving serious pneumonia and shortness of breath). The remaining 5 percent of patients were critically ill, having developed respiratory failure, septic shock, and/or multi-organ failure.

Although recovery times vary, the vast majority of people who get sick with COVID-19 will recover. People with mild cases recover within a few days, while those with more serious cases may take weeks or even months to recover, depending on the severity of their symptoms.

There is no clear understanding of the risk of death from COVID-19. Initial information from China suggested that death occurred in approximately 3 percent of infected individuals. That figure is likely too high, as many people with mild cases of the disease were not counted in the overall numbers. A separate analysis published in February 2020 of nearly 1,100 patients with lab-confirmed COVID-19 determined a 1.4 percent death rate. It will likely be some time before the actual rate is known. For comparison, the death rate of seasonal influenza is approximately 0.1 percent.

There is currently no effective treatment for the virus that causes COVID-19. Antibiotics are not successful against viruses; neither are flu-based antiviral medications such as Tamiflu and Relenza. Treatment is instead supportive, addressing the symptoms associated with the illness. This means providing fluids and fever-reducing medication and, in severe cases, treating symptoms associated with pneumonia or respiratory distress.

Possible vaccines and drug treatments are rapidly being developed. Genetic Engineering & Biotechnology News published a list of 35 potential treatment options under exploration as of March 2020. While some have already entered the clinical trial process, it will likely take 18 months before any vaccine would be ready for widespread use. The Milken Institute tracks the development of treatments and vaccines for COVID-19, using publicly available data that is regularly updated.

Coronavirus Disease 2019 Situation Summary from the Centers for Disease Control and Prevention

Coronavirus disease (COVID-19) from the World Health Organization

Coronavirus Disease 2019 Information for Travel from the Centers for Disease Control and Prevention