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FAQ: Dr. Kohli answers your questions about the coronavirus

9Health Expert Dr. Payal Kohli answers some of the most frequently-asked questions about the new coronavirus.

DENVER — Colorado’s first novel coronavirus, COVID-19 case, was announced on Thursday, March 5. COVID-19 is a virus that first appeared in Wuhan, China in late 2019.

Symptoms of the coronavirus can include fever, cough and trouble breathing. Most develop only mild symptoms. But some people, usually those with other medical complications, develop more severe symptoms, including pneumonia, which can be fatal.

Here’s a roundup of some of the most common questions about the coronavirus, answered by 9Health Expert, Dr. Payal Kohli.


How does the Coronavirus spread?

The virus spreads through infected respiratory droplets that usually require contact of <6 feet for direct transmission through respiratory droplets. 

Infection is possible through individuals that are asymptomatic or pre-symptomatic. It can also be spread through direct physical contact. 

For example, if someone coughs on his/her hand and transmits viral particles to their hand, and then shakes hands with you and you rub your nose or eyes and inoculate these viral particles into your nasal passages. Another possible mechanism is contact (i.e. touching) a contaminated surface that has viral particles on it and then touching your face, nose or mouth. 

There is some medical evidence that there may also be fecal-oral spread, meaning if someone goes to the bathroom and doesn’t wash his/her hands, it may be transmitted to you if he/she prepares your food. 

There was also a study that the virus particles may be airborne for up to 3 hours under some circumstances. 

While fecal-oral and airborne transmission may be possible, it is believed that respiratory droplets are the primary mechanism of spread. You should increase the distance >6 ft (and get as far as possible) if someone is sneezing, cough, laughing, jogging, singing or doing anything that may expel the respiratory droplets at a high velocity.

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What is the difference between coronavirus, SARS-CoV-2 and COVID-19?

Coronavirus is the family of viruses of which SARS-CoV-2 is a member.

SARS-CoV-2 is the virus which causes COVID-19 disease.

COVID-19 stands for “Coronavirus (COVI) Disease (D)-(20)19.”


Why are we now being told to wear masks when before we were told they don’t work?

The masks are being recommended now when they weren’t before because there appears to be more asymptomatic spread than was previously appreciated. There is also new evidence that the viral particles may linger in the air longer than previously suspected. Because of these reasons, the CDC is now recommending homemade cloth face coverings (not surgical grade masks, which need to be reserved for healthcare workers) for everyone. 

This is meant more to protect OTHERS from your droplets rather than to protect you from others. The fit and the material of the covering are important (tight-fitting, pillowcase or tea towel material) and be careful about touching your face more with the mask as this could increase your risk. Don’t stop social distancing because of a false sense of security as this is still important to protect YOU.

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What are the most common symptoms of COVID-19?

Fever, cough and shortness of breath. However, you can also have more systemic symptoms of fatigue, muscle aches, headaches. Some percentage of people have nasal congestion or sore throat and a very small percentage has gastrointestinal symptoms like diarrhea or nausea. 

We have also learned that some people can have no symptoms at all (asymptomatic carriers) and these are the ones who have to think about exposures. Some people are also presenting with loss of taste or smell as an early sign or the only sign of the virus. The shortness of breath symptoms should be a red flag that should prompt you to contact your medical provider immediately.


How do I know if my symptoms are consistent with the coronavirus or the flu or a cold?

You can’t tell based on symptoms alone. There is a significant amount of overlap in symptoms and at this point, if you have symptoms like fever or cough, you should assume it is COVID-19.


What should I do if I think I may have COVID-19 and when should I get tested?

Isolate yourself from your friends and family members. Wear a mask. Designate a bedroom/bathroom in the house for your use only that others are not using. Do not be the primary caregiver for your pets. If you have mild symptoms and are feeling well enough, you can manage yourself at home. Testing is limited in Colorado and may not be available to those with mild symptoms. 

Take Tylenol for fever reduction, drink fluids and get rest. If your symptoms are getting worse or if you develop more severe symptoms like shortness of breath, you need to call your healthcare provider. If you are in a “vulnerable” group (>65 years, chronic medical problems, pregnant or immunocompromised), call your healthcare provider to discuss whether you need COVID-19 testing.


Who is highest risk from this virus?

Studies have shown that 81% of adults will have mild or no symptoms. However, 19% of adults may have a serious or critical illness requiring hospitalization. The groups that are the highest risk include the elderly (risk increases in a graded fashion with age), those who are immunocompromised or those with chronic medical illnesses like lung disease, heart disease, obesity or diabetes. Pregnant women and neonates (<1 year of age) should also be careful. 

However, in a report from the CDC on March 18, 2020, about cases in the United States, 38% of hospital admissions, 48% of ICU admissions and 20% of deaths were in people <65 years of age. So, in short, everyone is at risk and should be extremely careful about social distancing.


Does the flu shot protect against COVID-19?

No. But the flu shot does offer protection for yourself (and your community) against the flu which is another respiratory virus that can increase the risk for you or your children.


What is the risk to kids?

Multiple studies have reported a low rate of infection in kids. In one study of 72,314 people from JAMA, the rate of infection in kids 1-10 years and in 10-20 years was <1%. In another study of 1099 people published in NEJM, there were only 0.9% of infections in kids <15 years. 

The rate of infection in kids is low, either because they are not getting the infection (have relative immunity), the symptoms are mild and therefore the infection is undetected or because they have a low risk of exposure. Regardless of which explanation it is, the risk in kids is low. 

The report from the CDC released on March 18, 2020 showed that there were no ICU admissions or deaths in children <19 years of age. Small studies in infants who have been infected have shown a low risk of dying but larger studies suggest that among children, infants may actually be higher risk for critical illness.


How long does the virus last on surfaces?

A study released from the New England Journal of Medicine states that the virus can last on surfaces like cardboard for 24 hours, on copper for 4 hours, on stainless steel and plastic for 3 days and can last in the air up to 3 hours. However, this time depends on what type of surface it is, what the environmental conditions are (temperature/humidity), how many viral particles were inoculated on the surface.


What is the risk to pregnant women and neonates?

We have limited data on pregnant women. In a small case study published in The Lancet of 9 pregnant women, the risk appears to be the same as the general population. The clinical characteristics reported in pregnant women with confirmed COVID-19 infection are similar to those reported for non-pregnant adults with confirmed COVID-19 infection in the general population and appear to be better than the prognosis was with SARS-CoV-1 infection (SARS), which resulted in significant maternal complications. In this study, mothers did not appear to transmit the infection to their newborn babies (“vertical transmission”) but there have been other studies and case reports of possible mom to baby transmission in utero (before birth).

But the caveat is are very few cases studied for a very short period of time, so more follow-up studies are needed to know the risk to pregnant women and newborn babies who develop COVID-19 infection. Pregnant women are susceptible to respiratory infections and to the development of severe pneumonia if they become infected, which possibly makes them more susceptible to COVID-19 infection than the general population, especially if they have chronic diseases or maternal complications. Therefore, pregnant women and newborn babies should be considered “at-risk” populations.


Once you get infected, can you have a re-infection?

Probably not. According to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease and member of White House Task Force on Coronavirus, we think this virus behaves like other respiratory viruses and once you have an infection, you likely develop immunity. 

However, there have been case reports of people who recovered from the virus and then have viral particles were detected in their blood. It is unclear whether this is significant and may just represent residual infection. It is possible that immunity may wane over time but this is likely to happen in the long term, not the short term.


What about groceries, packages and take-out food?

The virus can last on cardboard for 1 day and plastic for 3 days. Transfer all content from grocery bags or packages you are bringing into the home (or leave them outside in the garage). Wipe down all the cans, plastic containers with sanitizing wipes. Wash all fruit and produce in soap and warm water for 20 seconds before putting it in the fridge. 

Take out food’s greatest risk is from the packaging and interaction with the delivery person. Having said that, given the possibility of fecal-oral spread, there may be a slightly higher risk of contracting the virus if you get take-out rather than eating at home. Have the delivery person leave it outside. As soon as you get your take your food, put it in fresh containers, throw out the packaging and wash your hands. Microwave your food before eating it


Is there a treatment for COVID-19?

At this time, there are no approved treatments for COVID-19. Multiple clinical trials are ongoing to study medications that inhibit viral attachment to lung cells (chloroquine, hydroxychloroquine), viral replication (Remdesevir) and the inflammatory response. There is also a trial ongoing of using “convalescent serum” (antibodies from those who have recovered and injecting into those who are sick).

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