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STAY CALM —
Don’t Panic: The comprehensive Ars
Technica guide to the coronavirus
[Updated 3/17]
This is a fast-moving epidemic—we'll update this guide at 3pm EDT every day.
- 3/17/2020, 12:42 AM
More than 194,000 people have been infected with a new coronavirus that has spread widely from its
origin in China over the past few months. Over 7,800 have already died. Our comprehensive guide for
understanding and navigating this global public health threat is below.
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3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica
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This is a rapidly developing epidemic, and we will update this guide every day at 3pm EDT to keep you
as prepared and informed as possible.
March 8: Initial publication of the document.
March 9, 3pm ET: Added three new question-and-answer sections and updated case counts.
March 10, 3pm ET: Added one new question-and-answer section and updated case counts.
March 11, 3pm ET: Added a new section about claimed remedies and updated case counts.
March 12, 3pm ET: Updated the sections on US cases and how SARS-CoV-2 spreads. Updated global
case counts.
March 13, 3pm ET: Updated the answers to "Should I avoid large gatherings and travel?" and "How
does coronavirus transmission compare with flu?" Also updated global and US case counts.
March 14, 3pm ET: Updated global and US case counts.
March 15, 3pm ET: Updated global and US case counts.
March 16, 3pm ET: Updated global and US case counts. Updated guide on what to keep in your
medicine cabinet.
March 17, 3pm ET: Updated global and US case counts.
Table of Contents
How worried should I be?
What is SARS-CoV-2?
Where did SARS-CoV-2 come from?
How did it start infecting people?
What happens when you’re infected with SARS-CoV-2?
What are the symptoms?
How severe is the infection?
Who is most at risk of getting critically ill and dying?
Are men more at risk?
Are children less at risk?
How long does COVID-19 last?
How many people die from the infection?
How does COVID-19 compare with seasonal flu in terms of symptoms and deaths?
How does SARS-CoV-2 spread? [Updated 3/12/2020]
How does coronavirus transmission compare with flu? [Update 3/13/2020]
How contagious is it? [New, 3/9/2020]
Can I get SARS-CoV-2 from my pet? Can I give it to my pet? [New, 3/9/2020]
If I get COVID-19, will I then be immune or could I get re-infected? [New, 3/9/2020]
How likely am I to get it in normal life?
What can I do to prevent spread and protect myself?
Should I get a flu vaccine?
When, if ever, should I buy or use a face mask?
Should I avoid large gatherings and travel? [Updated 3/13/2020]
3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica
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What precautions should I take if I do travel?
Do quarantines, isolations, and social-distancing measures work to contain the virus? [New,
3/10/2020]
How should I prepare for the worst-case scenario?
Should I keep anything in my medicine cabinet for COVID-19? [Updated, 3/16/2020]
Can X home remedy or product prevent, treat, or cure COVID-19? [New, 3/11/2020]
Should I go to a doctor if I think I have COVID-19?
When should I seek emergency care?
Is the US healthcare system ready for this?
What are the problems with testing in the US?
***Current cases in the US [Updated, 3/17/2020]***
What could happen if healthcare facilities become overwhelmed?
When will all of this be over in the US?
Will SARS-CoV-2 die down in the summer?
Will it become a seasonal infection?
What about treatments and vaccines?
How worried should I be?
You should be concerned and take this seriously. But you should not panic.
This is the mantra public health experts have adopted since the epidemic mushroomed in January—
and it’s about as comforting as it is easy to accomplish. But it’s important that we all try.
This new coronavirus—dubbed SARS-CoV-2—is unquestionably dangerous. It causes a disease called
COVID-19, which can be deadly, particularly for older people and those with underlying health
conditions. While the death rate among infected people is unclear, even some current low estimates
are seven-fold higher than the estimate for seasonal influenza.
And SARS-CoV-2 is here in the US, and it's circulating—we are only starting to determine where it is
and how far it has spread. Problems with federal testing have delayed our ability to detect infections
in travelers. And as we work to catch up, the virus has kept moving. It now appears to be spreading in
several communities across the country. It’s unclear if we will be able to get ahead of it and contain it;
even if we can, it will take a lot of resources and effort to do it.
All that said, SARS-CoV-2 is not an existential threat. While it can be deadly, around 80 percent of
cases are mild to moderate, and people recover within a week or two. Moreover, there are obvious,
evidence-based actions we can take to protect ourselves, our loved ones, and our communities
overall.
Now is not the time for panic, which will only get in the way of what you need to be doing. While it’s
completely understandable to be worried, your best bet to getting through this unscathed is to
channel that anxious energy into doing what you can to stop SARS-COV-2 from spreading.
And to do that, you first need to have the most complete, accurate information on the situation as
you can. To that end, below is our best attempt to address all of the questions you might have about
3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica
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SARS-CoV-2, COVID-19, and the situation in the US.
We’ll start with where all of this starts—the virus itself.
What is SARS-CoV-2?
SARS-CoV-2 stands for severe acute respiratory syndrome coronavirus 2. As the name suggests, it’s a
coronavirus and is related to the coronavirus that causes SARS (Severe Acute Respiratory Syndrome).
Note: When SARS-CoV-2 was first identified it was provisionally dubbed 2019 novel coronavirus, or
2019-nCoV.
Coronaviruses are a large family of viruses that get their name from the halo of spiked proteins that
adorn their outer surface, which resemble a crown (corona) under a microscope. As a family, they
infect a wide range of animals, including humans.
With the discovery of SARS-CoV-2, there are now seven types of coronaviruses known to infect
humans. Four regularly circulate in humans and mostly cause mild to moderate upper-respiratory
tract infections—common colds, essentially.
The other three are coronaviruses that recently jumped from animal hosts to humans, resulting in
more severe disease. These include SARS-CoV-2 as well as MERS-CoV, which causes Middle East
Respiratory Syndrome (MERS), and SARS-CoV, which causes SARS.
In all three of these cases, the viruses are thought to have moved from bats—which have a large
number of coronavirus strains circulating—to humans via an intermediate animal host. Researchers
have linked SARS-CoV to viruses in bats, which may have moved to humans through masked palm
civets and raccoon dogs sold for food in live-animal street markets in China. MERS is thought to have
spread from bats to dromedary camels before jumping to humans.
Where did SARS-CoV-2 come from?
SARS-CoV-2 is related to coronaviruses in bats, but its intermediate animal host and route to humans
are not yet clear. There has been plenty of speculation that the intermediate host could be pangolins,
but that is not confirmed.
How did it start infecting people?
While the identity of SARS-CoV-2’s intermediate host remains unknown, researchers suspect the
mystery animal was present in a live animal market in Wuhan, China—the capital city of China’s
central Hubei Province and the epicenter of the outbreak. The market, which was later described in
Chinese state media reports as “filthy and messy,” sold a wide range of seafood and live animals,
some wild. Many of the initial SARS-CoV-2 infections were linked to the market; in fact, many early
cases were in people who worked there.
Public health experts suspect that the untidiness of the market could have led to the virus’ spread.
Such markets are notorious for helping to launch new infectious diseases—they tend to cram
humans together with a variety of live animals that have their own menageries of pathogens. Close
quarters, meat preparation, and poor hygienic conditions all offer viruses an inordinate number of
opportunities to recombine, mutate, and leap to new hosts, including humans
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That said, a report in The Lancet describing 41 early cases in the outbreak indicates that the earliest
identified person sickened with SARS-CoV-2 had no links to the market. As Ars has reported before,
the case was in a man whose infection began causing symptoms on December 1, 2019. None of the
man’s family became ill, and he had no ties to any of the other cases in the outbreak.
The significance of this and the ultimate source of the outbreak remain unknown.
The market was shut down and sanitized by Chinese officials on January 1 as the outbreak began to
pick up.
What happens when you’re infected with SARS-CoV-2?
In people, SARS-CoV-2 causes a disease dubbed COVID-19 by the World Health Organization (WHO).
As the US Centers for Disease Control and Prevention (CDC) points out, the ‘CO’ stands for ‘corona,’ ‘VI’
for ‘virus,’ and ‘D’ for disease.
What are the symptoms?
COVID-19 is a disease with a range of symptoms and severities, and we are still learning about the full
spectrum. So far, it seems to span from mild or potentially asymptomatic cases all the way to
moderate pneumonia, severe pneumonia, respiratory distress, organ failure and, for some, death.
Many cases start out with fever, fatigue and mild respiratory symptoms, like a dry cough. Most cases
don’t get much worse, but some do progress into a serious illness.
According to data from nearly 56,000 laboratory-confirmed COVID-19 patients in China, the rundown
of common symptoms went as follows:
88 percent had a fever
68 percent had a dry cough
38 percent had fatigue
33 percent coughed up phlegm
19 percent had shortness of breath
15 percent had joint or muscle pain
14 percent had a sore throat
14 percent headache
11 percent had chills
5 percent had nausea or vomiting
5 percent had nasal congestion
4 percent had diarrhea
Less than one percent coughed up blood or blood-stained mucus
Less than one percent had watery eyes
That data was published in a report by a band of international health experts assembled by the WHO
and Chinese officials (called the WHO-China Joint mission), who toured the country for a few weeks in
February to assess the outbreak and response efforts.
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How severe is the infection?
Most people infected will have a mild illness and recover completely in two weeks.
In an epidemiological study of 44,672 confirmed cases in China, authored by an emergency response
team of epidemiologists and published by the Chinese CDC, researchers reported that about 81
percent of cases were considered mild. The researchers defined mild cases as those ranging from the
slightest symptoms to mild pneumonia. None of the mild cases were fatal; all recovered.
Otherwise, about 14 percent were considered severe, which was defined as cases with difficult or
labored breathing, an increased rate of breathing, and decreased blood oxygen levels. None of the
severe cases were fatal; all recovered.
Nearly 5 percent of cases were considered critical. These cases included respiratory failure, septic
shock, and/or multiple organ dysfunction or failure. About half of these patients died.
Finally, 257 cases (0.6 percent) lacked severity data.
The overall fatality rate in the patients examined was 2.3 percent.
Who is most at risk of getting critically ill and dying?
Your risk of becoming severely ill and dying increases with age and underlying health conditions.
In the group of 44,672 cases discussed above, the highest fatality rates were among those aged 60
and above. People aged 60 to 69 had a fatality rate of 3.6 percent. The 70 to 79 age group had a
fatality rate of about 8 percent, and those 80 or older had a fatality rate of nearly 15 percent.
Additionally, the researchers had information about other health conditions for 20,812 of the 44,672
patients. Of those with additional medical information available, 15,536 said they had no underlying
health conditions. The fatality rate among that group was 0.9 percent.
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The fatality rates were much higher among the remaining 5,279 patients who reported some
underlying health conditions. Those who reported cardiovascular disease had a fatality rate of 10.5
percent. For patients with diabetes, the fatality rate was 7.3 percent. Patients with chronic respiratory
disease had a rate of 6.3 percent. Patients with high blood pressure had a fatality rate of 6.0 percent
and cancer patients had a rate of 5.6 percent.
Puzzlingly, men had a higher fatality rate than women. In the study, 2.8 percent of adult male patients
died compared with a 1.7 percent fatality rate among female patients.
Are men more at risk?
In multiple studies, researchers have noted higher case numbers in men than in women. The WHO
Joint Mission report found that men made up 51 percent of cases. Another study of 1,099 patients
found that men made up 58 percent of cases.
So far, it is unclear if these numbers are real or if they would even out if researchers looked at larger
numbers of cases. It’s also unclear if this bias may reflect differences in exposure rates, underlying
health conditions, or smoking rates that may make men more susceptible.
That said, sex differences have been seen in illnesses caused by SARS-CoV-2’s relatives, SARS-CoV and
MERS-CoV. There is some preliminary research looking into this in mice. Some findings suggest that
there may be a protective effect from the activity of the female hormone estrogen. Other research
has also suggested that genes found on the X chromosome that are involved in modulating immune
responses to viruses may also serve to better protect genetically female people, who have two X
chromosomes, compared with genetic males, who have only one X chromosome.
Enlarge / Graph showing the percentage of cases by age group (blue) and the fatality rates within each
age group (orange).
China
CDC
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Are children less at risk?
Yes, it appears so. In all of the studies and data so far, children make up tiny fractions of the cases
and have very few reported deaths. In the 44,672 cases examined by the Chinese CDC, less than one
percent were in children ages 0 to 9 years old. None of those cases was fatal. Similar findings have
been reported in other studies.
The WHO-China Joint Mission report also noted that children appear largely unscathed in this
epidemic, writing, “disease in children appears to be relatively rare and mild.” From the data so far,
they report that “infected children have largely been identified through contact tracing in households
of adults.”
An unpublished, un-peer-reviewed study of 391 cases in Shenzhen, China, seems to support that
observation. It noted that within households, children appeared just as likely to get infected as adults,
but they had milder cases. The study was posted March 4 on a medical preprint server.
Still, as the Joint Mission report noted, given the data available, it is not possible to determine the
extent of infection among children and what role that plays in driving the spread of disease and the
epidemic overall. “Of note,” the report went on, “people interviewed by the Joint Mission Team could
not recall episodes in which transmission occurred from a child to an adult.”
How long does COVID-19 last?
On average, it takes five to six days from the day you are infected with SARS-CoV-2 until you develop
symptoms of COVID-19. This pre-symptomatic period—also known as "incubation"—can range from
one to 14 days.
From there, those with mild disease tend to recover in about two weeks, while those with more
severe cases can take three to six weeks to recover, according to WHO Director-General Dr. Tedros
Adhanom Ghebreyesus, who goes by Dr. Tedros.
How many people die from the infection?
This is a difficult question to answer. The bottom line is that we don’t really know.
Case fatality rates (CFR)—that is, the number of infected people who will die from the infection—are
simply calculated by dividing the number of dead by the number of recovered plus dead. The CFRs
you’ve probably seen so far have likely been a crude version of this: deaths divided by total cases.
One problem with these crude calculations is that the cases we’re counting aren’t all resolved. Some
of the patients who are currently sick may later go on to die. In that situation, the patients' cases are
counted, but their deaths are not (yet). This skews the current calculation to make the CFR look
artificially low.
But a much larger concern is that we are undercounting the number of cases overall. Because most
of the COVID-19 cases that we know about are mild, health experts suspect that many more infected
people have not presented themselves to healthcare providers to be tested. They may have mistaken
their COVID-19 case for a common cold or didn’t notice it at all. In areas hard hit by COVID-19, there
may not have been enough testing capacity to detect all of the mild cases. If a large number of mild
cases are being missed in the total case count, it could make the CFR look artificially high.
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The best way to clear up this uncertainty is to wait until one of the local outbreaks is completely over
and then to do blood tests on the general population to see how many people were infected. Those
blood tests would look for antibodies that target SARS-CoV-2. (Antibodies are Y-shaped proteins that
the immune system makes to help identify and attack pathogens and other unfriendly invaders.) The
presence of antibodies against a specific germ in a person’s blood indicates that the person has been
exposed to that germ, either through infection or immunization. Screening the general population for
SARS-CoV-2 antibodies will give a clearer picture of how many people were actually infected—
regardless of whether they were symptomatic or diagnosed while sick. That number can then be
used to calculate an accurate CFR.
So far, some preliminary population screening for COVID-19 infections has been done in China,
specifically in Guangdong province. Screening of 320,000 people who went to a fever clinic suggested
that we may not be missing a vast number of mild cases. This in turn suggests that the CFRs we are
calculating now are not wildly higher than they should be. However, experts still suspect that many
mild cases are going unreported, and many still anticipate that the true CFR will be lower than what
we are calculating now.
Beyond getting the basic number of cases and deaths right, CFRs are also tricky because they can
vary by population, time, and place. We’ve already noted above that the CFR increases in patient
populations based on age, gender, and underlying health. But as time goes on, healthcare providers
will get collectively better at identifying and treating patients, thereby lowering the CFR.
Complicating these statistics further, the quality of healthcare differs from place to place. The CFR in
a resource-poor hospital may be higher than that in a resource-rich hospital. Additionally, health
systems overwhelmed in an outbreak may not be able to provide optimal care for every patient,
artificially increasing the CFR in those places.
This seems to be what we’ve seen in China so far. In the WHO-China Joint Mission report, the experts
noted that in Wuhan—where the outbreak began and where health systems have been crushed by
the number of cases—the CFR was a whopping 5.8 percent. The rest of China at the time had a CFR of
0.7 percent.
As of March 5, there were about 13,000 cases and 400 deaths reported outside of China’s Hubei
Province (where Wuhan is located). A crude calculation puts the CFR around 3 percent, but this
calculation will likely drift throughout the outbreak. We will update the current crude CFR periodically.
How does COVID-19 compare with seasonal flu in terms
of symptoms and deaths?
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Most cases of COVID-19 are mild and may feel similar to the seasonal flu before a person recovers.
Though the case fatality rate is not yet clear for COVID-19 (as noted above), it so far appears to be
significantly higher than the CFRs seen from seasonal flu in the US.
Overall CFRs for COVID-19 have hovered around 2 percent to 3 percent during the outbreak. As
reported by Kaiser Health News, Christopher Mores, a global health professor at George Washington
University, calculated the average 10-year mortality rate for flu in the US at 0.1 percent, based on CDC
data. Many experts use this figure, including Dr. Anthony Fauci, director of the National Institute of
Allergy and Infectious Diseases at the National Institutes of Health.
Likewise, WHO Director-General Dr. Tedros noted in a recent statement that “seasonal flu generally
kills far fewer than one percent of those infected.”
Still, a lower CFR doesn’t mean a low death toll. So far this flu season, the CDC estimates that up to 45
million Americans have been infected, hospitalizing up to 560,000 and killing 46,000.
Influenza remains a leading cause of death in the US.
How does SARS-CoV-2 spread? [Updated 3/12/2020]
SARS-CoV-2 spreads mainly in respiratory droplets—tiny, germ-toting globs that are launched from
the mouth or nose when you breathe heavily, talk, cough, or sneeze. Published data suggests that a
single sneeze can unleash 40,000 droplets between 0.5–12 micrometers in diameter. Once airborne,
these fall rapidly onto the ground and typically don’t land more than one meter away.
If any droplets containing SARS-CoV-2 land on a nearby person and gain access to the eyes, nose, or
mouth—or are delivered there by a germy hand—that person can get infected.
If droplets containing SARS-CoV-2 land on surfaces, they can get picked up by others who can then
contract the infection. According to epidemiologist Maria Van Kerkhove, an outbreak expert at the
WHO, SARS-CoV-2 appears to be like its relative, SARS-CoV, in that surface contamination does seem
to play a role in the epidemic.
It is unclear how long SARS-CoV-2 can survive on any given surface. A recent review published in The
Journal of Hospital Infection suggested that human-infecting coronaviruses in general may be able to
survive on surfaces for up to nine days. A new non-peer-reviewed, unpublished study led by
researchers at the US National Institutes of Health suggests that SARS-CoV-2 can last for hours to up
to three days on surfaces, lasting longest on plastic and steel surfaces. The study was posted on a
medical pre-print server March 10.
Likewise, the WHO says SARS-CoV-2 may survive on surfaces for anywhere from a few hours to
several days. The organization also notes that survival will depend on environmental factors, such as
temperature, humidity, and the type of surface.
SARS-CoV-2 is not thought to be transmitted in air, according to available data. However, the pre-print
study by NIH researchers suggests that it may survive in aerosols for up to three hours.
Regardless of where it is, as Dr. Van Kerkhove noted, SARS-CoV-2 is quickly killed by disinfecting
agents. As the review of coronavirus surface survival reported, the viruses are “efficiently inactivated
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by surface disinfection procedures with 62–71 percent ethanol, 0.5 percent hydrogen peroxide, or 0.1
percent sodium hypochlorite (bleach) within 1 minute.”
Last, genetic material from SARS-CoV-2 does seem to be shed in some patients' feces—potentially in
up to 30 percent of patients, according to the report by the WHO-China Joint Mission. A recent study
in JAMA also found the virus lurking in toilet bowl and bathroom sink samples. “However,” as the Joint
Mission report states, “the fecal-oral route does not appear to be a driver of COVID-19 transmission.”
Moreover, routine bathroom cleaning efficiently eliminated the infectious threat, the authors of the
JAMA article concluded.
How does coronavirus transmission compare with flu? [Update 3/13/2020]
In a press briefing on March 3, WHO Director-General Dr. Tedros emphasized that “this virus is not
SARS, it’s not MERS, and it’s not influenza. It is a unique virus with unique characteristics.”
“Both COVID-19 and influenza cause respiratory disease and spread the same way, via small droplets
of fluid from the nose and mouth of someone who is sick,” he said. “However… COVID-19 does not
transmit as efficiently as influenza, from the data we have so far. With influenza, people who are
infected but not yet sick are major drivers of transmission, which does not appear to be the case for
COVID-19.”
While media reports have widely circulated fears that asymptomatic people are silently spreading
COVID-19 around communities and countries, there is little data to back that up. In fact,
asymptomatic cases appear rare and potentially misclassified. Dr. Tedros noted that only 1 percent of
cases in China are reported as “asymptomatic.” And of that 1 percent, 75 percent do go on to develop
symptoms.
Though it is still unclear to what extent infected people may spread the virus before developing
symptoms, the WHO still reports that, based on the current data, the biggest drivers of COVID-19
spread are symptomatic people coughing and sneezing.
Moreover, the thrust of the epidemic in China has been from the spread of the virus through
households and close contacts, not unconnected community members.
How contagious is it? [New, 3/9/2020]
From current data, the basic reproduction number (R or R naught) for COVID-19 is estimated to be
between 2 and 2.5. That is, on average, a single infected person will go on to infect about two other
people within a susceptible population. (Because SARS-CoV-2 is new to humans, everyone is assumed
to be susceptible.)
The R generally is meant to represent an average. In this case, that means some people may infect
fewer than two people, while a small proportion may be so-called super spreaders, who shed the
virus more efficiently and infect far more than two additional people.
A few words of caution about interpreting R : first, as Ars has reported before, R is a complicated
calculation, and it isn’t necessarily intrinsic to a pathogen. R also doesn’t indicate how dangerous a
disease is or how far it will spread. Last, transmission is context- and time-specific.
So far in this outbreak, the WHO has reported that transmission of SARS-CoV-2 has primarily been
between people who have had contact with each other, such as family members. Also, transmission
0
0
0 0
0
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early in a case of COVID-19 (that is, 24 to 48 hours prior to noticeable symptom onset) does not seem
to be common. Transmission of SARS-CoV-2 tends to be seen later, when symptoms are apparent,
according to the WHO.
That’s in contrast to infections such as seasonal flu, which often spreads among unrelated people in
the community and often before symptoms are apparent.
Seasonal flu has an estimate R of around 1.3. The highly contagious measles has an often-cited R
range of 12 to 18, but some calculations have put the number at nearly 60.
In terms of the biology of what’s going on during transmission, many details remain unknown. So far,
it appears that SARS-CoV-2 gets into human cells by latching onto a receptor molecular on the
outside of cells called human angiotensin-converting enzyme 2 (ACE2). These receptors are on cells
found primarily in the lower respiratory tract. This may explain why COVID-19 includes fewer upper-
respiratory-tract infection symptoms, such as a runny nose, and why SARS-CoV-2 does not seem to
spread as readily in the pre-symptomatic period, like influenza.
That said, a non-peer-reviewed, unpublished study from Germany involving 9 COVID-19 patients
suggested that patients may have high levels of virus in their upper respiratory tracts in the first week
or so after symptoms are present. The study was posted March 8 in a medical pre-print server.
Can I get SARS-CoV-2 from my pet? Can I give it to my pet? [New, 3/9/2020]
Reports from Hong Kong recently raised concern that pets could be victims—or potentially sources—
of SARS-CoV-2 after testing on a dog owned by a COVID-19 patient returned a “weak positive” result.
Though members of the coronavirus family do infect animals, including dogs, experts at the WHO
and the CDC say that there’s no evidence that pets are getting sick from SARS-CoV-2 or transmitting
the virus to people.
“We don’t believe that this is a major driver of transmission,” WHO epidemiologist Maria Van
Kerkhove said in a March 5 press briefing. The dog in Hong Kong is only one case, she noted, and this
issue requires much more study to assess its significance.
That said, as a general precaution, the CDC does suggest that if you are sick with COVID-19, you
should try to “restrict contact with pets and other animals... just like you would around other people”
until more information about the virus and its spread are known.
The infected pup in Hong Kong is said to have no symptoms but has been placed under quarantine
as a precaution.
If I get COVID-19, will I then be immune or could I get re-
infected? [New, 3/9/2020]
The immune responses to a SARS-CoV-2 infection are not well understood, so there’s no clear answer
on long-term immunity at this time.
There have been reports—such as this one from Japan—of COVID-19 patients who have recovered
from the disease only to test positive for the virus again later. However, experts are skeptical that
these are truly cases of relapsed infections or reinfections.
0 0
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The tests used to determine if someone is infected rely on detecting tiny fragments of genetic
material from the virus. While this is a good indication that someone has been infected, it doesn’t
necessarily indicate that an infection is active or the genetic material is from an intact, infectious viral
particle. The tests may simply be picking up genetic remnants of a past infection.
How likely am I to get it in normal life?
Your risk of exposure depends on where you live and where you’ve recently traveled. In the US, the
virus is spreading in certain communities but is not thought to be circulating widely, according to the
CDC. Unless there have been a number of cases reported in your area, your risk is considered low.
That said, with more testing happening, more cases will appear daily. There are basic things you can
do to protect yourself and prepare for cases in your area.
What can I do to prevent spread and protect myself?
The most important things you can do to protect yourself from COVID-19 (as well as seasonal
respiratory infections, like flu and cold) is to practice good, basic hygiene. That is:
Wash your hands frequently and thoroughly.
Make sure you wash your hands with soap and water for 20 seconds—the time it takes you to
hum the Happy Birthday song twice. (One clever Twitter user came up with some alternative
tunes for your mitt-scrubbing pleasure.)
You should especially wash your hands before eating, after using the restroom, sneezing,
coughing, or blowing your nose.
If you can’t get to a sink, use a hand sanitizer that has at least 60 percent alcohol, the CDC says.
Avoid touching your face, particularly your eyes, nose, and mouth.
If you cough or sneeze, cover your face with your elbow or a tissue. If you use a tissue, throw
that tissue away promptly, then go wash your hands.
Avoid close contact with sick people. If you think someone has a respiratory infection, it’s safest
to stay 2 meters away.
If you are sick, try to stay home to get better and avoid spreading the infection.
Regularly disinfect commonly touched surfaces and items in your house, such as door knobs
and counter tops.
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Should I get a flu vaccine?
YES. Getting a flu vaccine will protect you from the seasonal influenza and help prevent you from
spreading that virus. Though the vaccine is not 100 percent effective, if you do still get sick with the
flu after you are vaccinated, your illness will be milder than if you did not get vaccinated.
Getting a flu vaccine is something you should do every year to protect yourself and your community,
including those most vulnerable to the infection and those who cannot get vaccinated for medical
reasons. But, amid the COVID-19 epidemic, getting a flu shot is even more important.
The WHO-recommended method for hand washing.
WHO
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COVID-19 can resemble the symptoms of influenza. If people are vaccinated against the flu and there
are few cases of flu in an area, it may make spotting new COVID-19 cases easier. Moreover,
healthcare systems around the country are already stretched thin by flu patients who need care and
hospitalization each season. In this flu season so far, the CDC estimates that flu is responsible for up
to 21 million medical visits and 560,000 hospitalizations.
Fewer flu patients means more healthcare resources can be directed to detect and treat COVID-19
cases and thwart the epidemic.
When, if ever, should I buy or use a face mask?
If you are not sick, do not buy a face mask. If you have one already and you are well, it is not
recommended that you use it.
Face masks are now in short supply globally, and prices have surged. This is making it difficult for
healthcare workers to get the supplies they need to keep themselves safe so they can stay healthy,
keep treating patients, and avoid spreading the infection. This tragic situation is exacerbating the
outbreak.
In a March 3 plea, the WHO called on industry and governments to step up production of masks and
help thwart inappropriate buying.
“The World Health Organization has warned that severe and mounting disruption to the global supply
of personal protective equipment (PPE)—caused by rising demand, panic buying, hoarding and
misuse—is putting lives at risk from the new coronavirus and other infectious diseases,” the agency
said in a statement.
“We can’t stop COVID-19 without protecting health workers first,” WHO Director-General Dr. Tedros
said.
In addition to putting healthcare workers at risk, wearing a mask may also put you at risk. For one
thing, face masks are not entirely effective. Masks still leave your eyes exposed—if rubbed with
germy hands, they can be an entry point for viruses. Surgical masks are loose-fitting and leave open
the possibility of infectious particles working their way around the mouth. Even the use of N95
respirators, which are designed to protect against respiratory droplets, may not be that helpful to
you, since they require proper fitting, and many people do not wear them correctly or consistently.
Some experts suggest that when members of the public wear face masks, they tend to fuss with
them and touch their faces more. This increases the risk of transferring pathogens from hands to
entry points. Also, if you touch the outside surface of a contaminated face mask, you can then
contaminate your hand and go on to infect yourself. This negates the purpose of wearing a face
mask.
Last, some health experts worry that wearing face masks may give people a false sense of security,
potentially making them lax about other precautions and protections.
The only time experts recommend that members of the public wear a mask is if they are caring for a
sick person or are already sick and showing signs of COVID-19. In that case, wearing a mask could
reduce the risk that you will spread the infection to others.
Otherwise, masks should be reserved for healthcare workers.
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Should I avoid large gatherings and travel? [Updated
3/13/2020]
Yes.
If you live in the US, experts say that now is the time for social distancing measures—that is, putting
distance between you and other people as much as possible. Avoid gatherings, unnecessary outings,
and any unnecessary travel. If you can work from home, do so. School systems are already starting to
close in many places. If yours hasn’t yet, start making plans of what you’ll do if or when it does. If you
need to go to the doctor, call ahead and ask about tele-health options.
If you must go out or travel, try to stay 2 meters (about 6 feet) away from people. Practice good
hygiene: wash your hands with soap and water frequently, cough and sneeze into your elbow, avoid
touching your face.
Social distancing “is not a panacea,” Dr. Michael Ryan, executive director of WHO’s Health
Emergencies Program, cautioned in a press briefing March 13. This isn’t going to stop the epidemic,
he explained, but it will slow it down and allow health systems to better cope with the burden of
mounting COVID-19 cases.
Though most cases of COVID-19 are mild, many will require hospitalization. In a study of 44,672 cases
in China, around 14 percent needed hospitalization. If a scenario close to this plays out in the US,
every hospital bed in the US may be occupied by mid-May, according to some estimates.
Social distancing may help avoid or delay that. But ultimately the way to stop the epidemic is for
officials to start widespread testing, identify cases, put infected people in isolation, trace their
contacts, put them in quarantine, and continue monitoring.
So far, that has not been happening in the US. The country’s response has been severely crippled by
extremely limited and slow testing. As a country, we are not doing enough testing to know how far
SARS-CoV-2 has spread in communities now, let alone to prevent further spread.
The worst of the outbreak is yet to come for the US, Dr. Anthony Fauci, director of the NIH’s National
Institute of Allergy and Infectious Diseases, said in a Congressional hearing on Wednesday, March 11.
"I can say we will see more cases, and things will get worse than they are right now," Fauci said. "How
much worse we'll get will depend on our ability to do two things: to contain the influx of people who
are infected coming from the outside, and the ability to contain and mitigate within our own country."
For those who must travel internationally, the CDC provides risk assessments and travel guidance on
its website here.
For people outside of the US, in areas where SARS-CoV-2 is not yet known to be circulating, the
original response from 3/8/2020 is below:
Unfortunately, there is no clear or general answer to the question of travel and attending large
gatherings. Like your risk of exposure generally, risk from attending events and traveling depend on
where you are and where you are going.
Any time you’re faced with such a decision amid this epidemic, you should consider not only your
local risk but also whether you will encounter people from high risk areas while traveling to the event
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FURTHER READING
or once you are at it.
For local events largely attended by local people in communities where there are no or limited cases,
attending is considered low risk. Traveling to or through areas experiencing large clusters of cases will
certainly increase your risk of contracting COVID-19. Attending a conference where there will be
groups of people from high-risk areas also increases your risk.
But of course, these risk assessments only hold up if we have a firm grasp of where the virus is
circulating. Right now, we’re not in a good place to assess this, according to Harvard epidemiology
professor Marc Lipsitch.
“A month ago, it was easier to answer and, I think, a month from now it will be easier to answer,”
Lipsitch said in a COVID-19 forum at Harvard on March 2. “Right now, it’s possibly the hardest time to
answer.”
Earlier, the outbreak was mostly in China’s Hubei Province, so it was easy to recommend travel
restrictions to and from there. And a month from now, the virus may be so widespread that traveling
doesn’t change your risk much—or it could be contained and it will be clear which places are low or
high risk (we can hope).
But for now, the virus is scattering around the globe. It’s hard to pin down which places are low and
high risk. With new cases popping up continually, the situation in any given place can change at a
dizzying pace.
For anyone facing criticism of being too cautious, Lipsitch did say that “limiting optional travel makes
a lot of sense.” High risk or not, “it’s part of a response to try to slow this down.”
What precautions should I take if I do travel?
If you must travel, avoid contact with sick people, wash your hands frequently, use hand sanitizer,
and avoid touching your face.
If you’re traveling by air, avoid layovers in high-risk areas.
Do quarantines, isolations, and social-distancing
measures work to contain the virus? [New, 3/10/2020]
Yes, for the most part.
When the epidemic of COVID-19 first exploded out of Wuhan in January, officials in China and other
countries began issuing quarantines, imposing social-distancing measures, and setting travel
restrictions.
China locked down tens of millions of people in late January, for instance. In the Hubei province,
where Wuhan is located, officials implemented so called “social distancing measures,” cancelling
events and gatherings, closing schools, having people stay at home, and upping sanitation and
hygiene measures. Meanwhile, other countries issued travel restriction. The United States, for
instance, barred entry of some foreign nationals with recent travel to China.
Some public health experts were critical of the moves,
calling some of them draconian and ineffective. For
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Americans on coronavirus cruise
ship barred from US after failed
quarantine
instance, quarantines, which can clumsily round up the
sick with the healthy, may not prevent the spread of
disease—which we certainly saw on the Diamond
Princess cruise ship, quarantined in Japan. And travel
restrictions in our highly-connected world are inevitably leaky.
But proponents of the policies were quick to argue that the measures were never intended to
hermetically seal off cities or countries. Rather, the moves were intended to slow down the spread of
disease. This can buy officials time to prepare, help avoid overwhelming healthcare facilities with a
burst of cases, and in the end, lower the overall case counts in an epidemic.
According to the latest data, those proponents of the measures were, on the whole, correct.
In the WHO-China Joint Mission report, the group of experts estimated that China’s massive efforts to
contain the virus have “averted or at least delayed hundreds of thousands of COVID-19 cases in the
country.” This, in turn, had helped blunt the impact on the rest of the globe, they add.
Further, in a new non-peer-reviewed, unpublished study, an international team of researchers
estimated that without the measures, the number of cases in mainland China would have been 67-
times higher. And if officials had begun implementing them just one week earlier, cases could have
been reduced by 66 percent. If they had implemented them three weeks earlier, cases would have
been reduced by 95 percent. The study appeared on a medical pre-print server March 9.
Likewise, in another non-peer-reviewed, pre-print study, this one led by epidemiologists at Harvard,
researchers estimate that early interventions—quarantines, social distancing, contact tracing, etc.—
successfully and dramatically blunted the peak burden of disease in the Chinese city of Guangzhou.
In a Twitter thread March 10, one of the coauthors of that study, Harvard epidemiologist Marc
Lipsitch, noted that as community spread increases, social distancing—however painful—becomes
Enlarge
CDC
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essential to slowing and minimizing the impact of disease.
In the thread, he references a comparison of outbreaks of the 1918 pandemic flu in Philadelphia and
St. Louis. In Philadelphia, authorities downplayed the spread of disease and did not issue social-
distancing measures quickly. They even went forward with a city-wide parade as the disease spread.
St. Louis, on the other hand, quickly implemented social distancing measures within days of the
area’s first reported cases. The graph below shows how well things worked out for each city.
Enlarge
PNAS,
Richard
J.
Hatchett,
Carter
E.
Mecher,
and
Marc
Lipsitch,
2007
How should I prepare for the worst-case scenario?
This epidemic is unpredictable, and it is possible that it could begin spreading in your community.
That might lead to problems in the supply chain of various foods and goods—such as masks. It might
also mean that local authorities will recommend “social distancing” measures, asking that you spend
more time at home as events and gatherings get cancelled. Schools may close down for periods to try
to stop disease spread. Employers may recommend working from home when possible, and
healthcare providers may push the use of tele-health services.
In the event you get sick with COVID-19, you will likely face a two-week isolation period at home,
unless your illness becomes severe and you require medical care at a hospital.
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Experts suggest that if you haven’t already, go ahead and start putting together an emergency stash
of food and supplies for these scenarios, but do not panic buy and do not hoard. Just pick up a few
extra items on your routine shopping trips that will help make sure you don’t run out of food if you’re
stuck in your house for two weeks. Stick with shelf-stable items that you’ll use regardless of how this
epidemic plays out—things like dried pasta, canned foods, beans, lentils, peanut butter, trail mix,
nuts, shelf-stable or powdered milk, coffee, cereal, cooking oil, and other grains.
Since it’s unlikely that we will lose power or municipal water, it’s probably safe to stock up on some
frozen items you normally eat—and you can skip buying a lot of bottled water.
In addition to food, you should think about having some extra supplies of home goods and medicines
on hand. If you take prescription medications, try to have extra doses (though this can be difficult to
do).
Keep your home comfortably stocked with things like toilet paper, tissues, diapers, soap, cleaning
products and sanitizers, pet foods, and feminine products. Again, don’t hoard. Just buy a bit extra in
case you need to skip a routine shopping trip or two.
If things look like they’re going to get really bad in terms of supply-chain issues, you can dash out in
the eleventh hour to pick up whatever dairy, produce, meat, or baked goods you can get.
The CDC has a detailed list of other items to keep on hand in general emergencies.
Should I keep anything in my medicine cabinet for COVID-19? [Updated,
3/16/2020]
With most mild to moderate cases involving nonspecific, flu-like symptoms, you may want to make
sure you have enough fever-reducer/pain reliever, such as ibuprofen or acetaminophen (see the
update below).
You might also want to consider keeping over-the-counter treatments for colds around, just because
it’s that season. Upper respiratory symptoms like productive coughs and nasal congestion were not
common symptoms of COVID-19, but they are sometimes present.
Otherwise, there aren’t specific treatments.
Update: A note about ibuprofen as well as ACE inhibitors, angiotensin II type-I receptor blockers
(ARBs), and other anti-inflammatory drugs that may be used to treat diabetes and cardiovascular
disease:
There have been hypotheses and speculation that these drugs could increase people’s risk of being
infected with SARS-CoV-2 or make COVID-19 cases more severe. Some researchers have hypothesized
that this may be the case because these drugs could increase a person’s amount of ACE2 receptors.
These are molecules on the outside of some human cells that SARS-CoV-2 can latch onto, allowing the
virus to get into those cells and replicate.
Some officials have even suggested that COVID-19 patients avoid taking ibuprofen for fever and pain
and stick with acetaminophen (Tylenol).
So far, there is not sufficient evidence to support the hypothesis or the clinical recommendation.
Some medical experts, including the European Society of Cardiology, have even made a point to
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FURTHER READING
FDA, FTC slam 7 companies selling
bogus COVID-19 cures
release statements urging patients to continue taking their prescription medications.
Some experts have noted that favoring acetaminophen to treat COVID-19, out of an abundance of
caution, isn’t a terrible idea. But people should follow dosages carefully since the drug can be toxic to
the liver.
We'll update this section as more information is available.
Can X home remedy or product prevent, treat, or cure COVID-19? [New,
3/11/2020]
A word of caution about misinformation and fraudulent claims.
Like any pressing health topic, there will be plenty of
people attempting to exploit the situation for personal
gain, whether it be money or status (particularly on
social media). The Internet is rife with false information
about SARS-CoV-2 and COVID-19 as well as bogus products and strategies to combat them. This will
likely intensify as the pandemic escalates in the United States.
As the FDA noted in an enforcement action this week: there are currently no vaccines or drugs
approved to treat or prevent COVID-19.
“Although there are investigational COVID-19 vaccines and treatments under development, these
investigational products are in the early stages of product development and have not yet been fully
tested for safety or effectiveness,” the agency says.
So, no, eating lots of garlic and huffing essential oils won’t ward off COVID-19. Spraying colloidal silver
up your nose won’t stop SARS-CoV-2 from invading. Getting vaccines that protect against other
pathogens—such as the influenza virus or bacteria that cause pneumonia, such as Streptococcus
pneumoniae (pneumococcus)—are also not going to prevent COVID-19. (For more examples, the WHO
has a site dedicated to myth busting.)
These fraudulent claims waste money, give people a false sense of security, delay actual medical care
and treatments, and can sometimes be outright dangerous.
Should I go to a doctor if I think I have COVID-19?
If you believe you have COVID-19, the CDC advises you should call your healthcare provider—do not
make an unannounced office visit. Your healthcare provider, with the help of your state’s health
department and the CDC, can determine if you should come in and get tested. Obvious reasons to
test include the presence of COVID-19-like symptoms, having had contact with someone known to be
infected, living in a place where transmission is occurring, or if you have recently traveled to a place
where transmission is occurring.
If you do have COVID-19, getting tested can help local health departments track the virus’ spread and
identify contacts who may have also been exposed. Once your case is confirmed, your healthcare
provider and local health department can work with you to monitor and manage your health and
assess when you’re no longer at risk of spreading the infection.
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But it’s important that you call ahead before going to a healthcare provider if you’re concerned you
have COVID-19. This will help determine if you can and should be tested and provide your healthcare
provider with a chance to prepare the office so you will not potentially expose people in the facility or
patients in the waiting room to the virus.
If a healthcare provider has you come in for a test, the CDC recommends wearing a mask and, as
always, practicing good hygiene.
When should I seek emergency care?
If you have a confirmed case of COVID-19 or if you have a suspected case and your condition
worsens and you have trouble breathing, call your doctor immediately to seek prompt medical care.
If your condition becomes an emergency, call 911 and inform them that you may have COVID-19.
Wear a mask if possible when emergency responders arrive.
Is the US healthcare system ready for this?
As experts at the WHO have repeatedly warned, COVID-19 can put enormous strain on healthcare
systems. For weeks, they have been advising for countries to get ready and have a plan.
So far, there have been worrying signs that the US healthcare system has not heeded this warning.
Last week, news broke of a whistleblower allegation that the Department of Health and Human
Services sent dozens of untrained employees without protective gear to help manage repatriated
citizens at high risk of COVID-19 and under quarantine.
On March 5, The New York Times reported that nurses in Washington and California—where SARS-
CoV-2 is circulating in some communities—have had to beg for masks and have been pulled from
quarantines to treat patients.
In a survey of more than 6,500 nurses in 48 states by National Nurses United, a nationwide union of
nurses, only 29 percent reported that their hospitals had plans in place to isolate possible COVID-19
cases. Only 44 percent said their employer had provided them with guidance on how to respond to
potential COVID-19 cases, and only 63 percent said they had access to N95 respirators.
There have also been anecdotal reports from Washington and California of people trying to get
tested for the virus but being told that there were no tests available.
What are the problems with testing in the US?
Testing for COVID-19 in the US has been a tragic debacle.
The CDC was tasked with coming up with a diagnostic test to detect SARS-CoV-2 in respiratory
samples from patients. The agency developed an RT-PCR test for the new virus and sent testing kits
beginning in early February to states. But, as the agency notes on its website, “shortly thereafter
performance issues were identified related to a problem in the manufacturing of one of the reagents
which led to laboratories not being able to verify the test performance.”
While the CDC has been mum about what exactly went wrong, a report in Science suggests that the
problem was with a negative control in the kit—a sample designed to produce a negative test result.
Should that control return a positive result, it would render test results uninterpretable, since there's
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no way of knowing if positive results are actually due to the presence of the virus. A report in Axios
suggests that the problem may have been due to contamination.
The problem took the agency weeks to resolve, and many states weren’t able to ramp up testing until
the end of February and start of March. “This has not gone as smoothly as we would have liked,” Dr.
Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases,
said in a press briefing February 28.
The testing snag cost the country precious time in detecting imported cases, isolating them, and
tracing their contacts—critical steps needed to contain the virus.
Now, in early March, things are improving. The CDC has worked out the problem with its tests, the
FDA has loosened regulations on who can design their own tests, and commercial tests are coming
online to provide additional kits to states.
Unsurprisingly, in the first few days of increased testing capacity, the number of confirmed cases in
the US exploded.
***Current cases in the US [Updated, 3/17/2020]***
As of March 17 at 3pm, there have been more than 5,700 cases detected nationwide and at least 94
deaths. With testing for COVID-19 in the US severely delayed and still dangerously limited, the
number of actual cases is expected to be much higher.
Now, 49 states, the District of Columbia, Puerto Rico, Guam, and the US Virgin Islands are reporting
cases. West Virginia Is the only state that has yet to report a case.
Here is the latest map from the CDC on March 16 showing affected states, with a color gradient
indicating case ranges in each state. Note that the CDC data sometimes lags behind some case
reporting by state and local health departments. This map is sometimes missing cases and states, but
you can get a general idea of the country’s situations. Generally, for a more up-to-date reference, you
can check out the global COVID-19 dashboard, put together by researchers at Johns Hopkins
University.
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The three states hardest hit are Washington, California, and New York.
Washington state is currently reporting 904 cases and 48 deaths. The state reported the first case in
the whole of the United States back in January. A Seattle-area man in his 30s developed symptoms
after returning from a trip to the area around Wuhan, China, where the outbreak began. The current
outbreak in the state may link back to that initial case, according to preliminary genetic analyses.
New York state is reporting 1,374 cases and 12 deaths. Of the cases, 644 are in New York City and 380
are from Westchester County, a suburb of New York City that has experienced a large outbreak. On
March 14, New York City Mayor Bill de Blasio announced the state’s first death in an elderly woman
with advanced emphysema. “We all have a part to play here,” he said in the announcement. “I ask
every New Yorker to do their part and take the necessary precautionary measures to protect the
people most at risk.”
California is reporting 472 cases and 11 deaths. The state has housed hundreds of quarantined
citizens repatriated from China and passengers from two coronavirus-stricken cruise ships.
What could happen if healthcare facilities become
overwhelmed?
If the situation in the US or in certain communities gets out of hand—and it’s not at all clear if this will
happen—hospitals and healthcare facilities may not be able to handle the number of COVID-19
patients seeking care. This could lead to suboptimal care for those patients, potentially increasing the
case fatality rate in the country.
Enlarge
CDC
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If healthcare systems are overwhelmed, the severe and critical cases will likely get priority, potentially
allowing mild cases to go undetected and untreated. This could in turn allow the virus to keep
spreading.
Again, it is unclear if this will happen. It is a worst-case scenario that can, in part, be avoided if
individuals do their part to stop the spread of the disease with hygiene recommendations and
mitigation efforts such as social distancing.
When will all of this be over in the US?
No one knows. Such epidemics are extremely unpredictable, but experts expect that COVID-19 will be
with us for at least the coming weeks and months.
Will SARS-CoV-2 die down in the summer?
So far, we have no evidence that SARS-CoV-2 will be stifled by warming temperatures, WHO
epidemiologist Maria Van Kerkhove says.
It’s unclear exactly why influenza and other respiratory viruses tend to peak in colder months. Some
evidence suggests that the lower temperatures and lower humidity may help viruses spread. But we
don't know if that's true for this coronavirus.
Will it become a seasonal infection?
This is also unknown, but some epidemiologists—including Harvard’s Marc Lipsitch—suggest that
SARS-CoV-2 could be with us indefinitely and that we will eventually see it return in seasonal waves.
What about treatments and vaccines?
Since the epidemic began in January, researchers have rushed to start clinical trials and begun
developing vaccine candidates. There are now dozens of vaccine efforts underway.
The National Institute of Allergy and Infectious Diseases at the National Institutes of Health has
partnered with biotechnology company Moderna to test a vaccine candidate based on messenger
RNA that will cause an individual's cells to produce a viral protein without an infection. An early
clinical trial in people is expected to start in the coming weeks. If it is successful, a usable vaccine will
still take at least a year and a half, according to NIAD’s director, Dr. Fauci—and that is a very
optimistic estimate.
Meanwhile, researchers and biotech companies are also working on treatments for COVID-19.
On February 25, the NIH announced that a clinical trial has begun to test whether an experimental
antiviral drug called remdesivir can help COVID-19 patients hospitalized in Nebraska Medical Center
(UNMC) in Omaha.
Researchers are also working on plasma-derived treatments, which have some positive anecdotal
reports. The basic idea behind plasma therapy is to harvest antibodies against SARS-CoV-2 from the
blood plasma of infected patients after they’ve recovered. Those collected antibodies can then be
injected into newly infected patients, where they could bolster immune responses, potentially
3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica
https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 26/27
READER COMMENTS 2655 SHARE THIS STORY
BETH MOLE
Beth is Ars Technica’s health reporter. She’s interested in biomedical research, infectious disease, health
policy and law, and has a Ph.D. in microbiology.
EMAIL beth.mole@arstechnica.com // TWITTER @BethMarieMole
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improving outcomes and shortening recovery times. On March 4, Takeda Pharmaceutical Company
announced that it is beginning work on a plasma-derived therapy for COVID-19.
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3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica
https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 27/27
SpaceX launches its
Starlink satellites, but
misses another landing
[Updated]
Reputable sites swept up
in FB’s latest
coronavirus-minded
spam cleanse [Updated]
A tech bro opts for a
digital afterlife in first
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Don’t panic the comprehensive ars technica guide to the coronavirus [updated 3 17] _ ars technica

  • 1. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 1/27 STAY CALM — Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] This is a fast-moving epidemic—we'll update this guide at 3pm EDT every day. - 3/17/2020, 12:42 AM More than 194,000 people have been infected with a new coronavirus that has spread widely from its origin in China over the past few months. Over 7,800 have already died. Our comprehensive guide for understanding and navigating this global public health threat is below. Enlarge Aurich Lawson / Getty BETH MOLE SUBSCRIBE SIGN IN
  • 2. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 2/27 This is a rapidly developing epidemic, and we will update this guide every day at 3pm EDT to keep you as prepared and informed as possible. March 8: Initial publication of the document. March 9, 3pm ET: Added three new question-and-answer sections and updated case counts. March 10, 3pm ET: Added one new question-and-answer section and updated case counts. March 11, 3pm ET: Added a new section about claimed remedies and updated case counts. March 12, 3pm ET: Updated the sections on US cases and how SARS-CoV-2 spreads. Updated global case counts. March 13, 3pm ET: Updated the answers to "Should I avoid large gatherings and travel?" and "How does coronavirus transmission compare with flu?" Also updated global and US case counts. March 14, 3pm ET: Updated global and US case counts. March 15, 3pm ET: Updated global and US case counts. March 16, 3pm ET: Updated global and US case counts. Updated guide on what to keep in your medicine cabinet. March 17, 3pm ET: Updated global and US case counts. Table of Contents How worried should I be? What is SARS-CoV-2? Where did SARS-CoV-2 come from? How did it start infecting people? What happens when you’re infected with SARS-CoV-2? What are the symptoms? How severe is the infection? Who is most at risk of getting critically ill and dying? Are men more at risk? Are children less at risk? How long does COVID-19 last? How many people die from the infection? How does COVID-19 compare with seasonal flu in terms of symptoms and deaths? How does SARS-CoV-2 spread? [Updated 3/12/2020] How does coronavirus transmission compare with flu? [Update 3/13/2020] How contagious is it? [New, 3/9/2020] Can I get SARS-CoV-2 from my pet? Can I give it to my pet? [New, 3/9/2020] If I get COVID-19, will I then be immune or could I get re-infected? [New, 3/9/2020] How likely am I to get it in normal life? What can I do to prevent spread and protect myself? Should I get a flu vaccine? When, if ever, should I buy or use a face mask? Should I avoid large gatherings and travel? [Updated 3/13/2020]
  • 3. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 3/27 What precautions should I take if I do travel? Do quarantines, isolations, and social-distancing measures work to contain the virus? [New, 3/10/2020] How should I prepare for the worst-case scenario? Should I keep anything in my medicine cabinet for COVID-19? [Updated, 3/16/2020] Can X home remedy or product prevent, treat, or cure COVID-19? [New, 3/11/2020] Should I go to a doctor if I think I have COVID-19? When should I seek emergency care? Is the US healthcare system ready for this? What are the problems with testing in the US? ***Current cases in the US [Updated, 3/17/2020]*** What could happen if healthcare facilities become overwhelmed? When will all of this be over in the US? Will SARS-CoV-2 die down in the summer? Will it become a seasonal infection? What about treatments and vaccines? How worried should I be? You should be concerned and take this seriously. But you should not panic. This is the mantra public health experts have adopted since the epidemic mushroomed in January— and it’s about as comforting as it is easy to accomplish. But it’s important that we all try. This new coronavirus—dubbed SARS-CoV-2—is unquestionably dangerous. It causes a disease called COVID-19, which can be deadly, particularly for older people and those with underlying health conditions. While the death rate among infected people is unclear, even some current low estimates are seven-fold higher than the estimate for seasonal influenza. And SARS-CoV-2 is here in the US, and it's circulating—we are only starting to determine where it is and how far it has spread. Problems with federal testing have delayed our ability to detect infections in travelers. And as we work to catch up, the virus has kept moving. It now appears to be spreading in several communities across the country. It’s unclear if we will be able to get ahead of it and contain it; even if we can, it will take a lot of resources and effort to do it. All that said, SARS-CoV-2 is not an existential threat. While it can be deadly, around 80 percent of cases are mild to moderate, and people recover within a week or two. Moreover, there are obvious, evidence-based actions we can take to protect ourselves, our loved ones, and our communities overall. Now is not the time for panic, which will only get in the way of what you need to be doing. While it’s completely understandable to be worried, your best bet to getting through this unscathed is to channel that anxious energy into doing what you can to stop SARS-COV-2 from spreading. And to do that, you first need to have the most complete, accurate information on the situation as you can. To that end, below is our best attempt to address all of the questions you might have about
  • 4. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 4/27 SARS-CoV-2, COVID-19, and the situation in the US. We’ll start with where all of this starts—the virus itself. What is SARS-CoV-2? SARS-CoV-2 stands for severe acute respiratory syndrome coronavirus 2. As the name suggests, it’s a coronavirus and is related to the coronavirus that causes SARS (Severe Acute Respiratory Syndrome). Note: When SARS-CoV-2 was first identified it was provisionally dubbed 2019 novel coronavirus, or 2019-nCoV. Coronaviruses are a large family of viruses that get their name from the halo of spiked proteins that adorn their outer surface, which resemble a crown (corona) under a microscope. As a family, they infect a wide range of animals, including humans. With the discovery of SARS-CoV-2, there are now seven types of coronaviruses known to infect humans. Four regularly circulate in humans and mostly cause mild to moderate upper-respiratory tract infections—common colds, essentially. The other three are coronaviruses that recently jumped from animal hosts to humans, resulting in more severe disease. These include SARS-CoV-2 as well as MERS-CoV, which causes Middle East Respiratory Syndrome (MERS), and SARS-CoV, which causes SARS. In all three of these cases, the viruses are thought to have moved from bats—which have a large number of coronavirus strains circulating—to humans via an intermediate animal host. Researchers have linked SARS-CoV to viruses in bats, which may have moved to humans through masked palm civets and raccoon dogs sold for food in live-animal street markets in China. MERS is thought to have spread from bats to dromedary camels before jumping to humans. Where did SARS-CoV-2 come from? SARS-CoV-2 is related to coronaviruses in bats, but its intermediate animal host and route to humans are not yet clear. There has been plenty of speculation that the intermediate host could be pangolins, but that is not confirmed. How did it start infecting people? While the identity of SARS-CoV-2’s intermediate host remains unknown, researchers suspect the mystery animal was present in a live animal market in Wuhan, China—the capital city of China’s central Hubei Province and the epicenter of the outbreak. The market, which was later described in Chinese state media reports as “filthy and messy,” sold a wide range of seafood and live animals, some wild. Many of the initial SARS-CoV-2 infections were linked to the market; in fact, many early cases were in people who worked there. Public health experts suspect that the untidiness of the market could have led to the virus’ spread. Such markets are notorious for helping to launch new infectious diseases—they tend to cram humans together with a variety of live animals that have their own menageries of pathogens. Close quarters, meat preparation, and poor hygienic conditions all offer viruses an inordinate number of opportunities to recombine, mutate, and leap to new hosts, including humans
  • 5. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 5/27 That said, a report in The Lancet describing 41 early cases in the outbreak indicates that the earliest identified person sickened with SARS-CoV-2 had no links to the market. As Ars has reported before, the case was in a man whose infection began causing symptoms on December 1, 2019. None of the man’s family became ill, and he had no ties to any of the other cases in the outbreak. The significance of this and the ultimate source of the outbreak remain unknown. The market was shut down and sanitized by Chinese officials on January 1 as the outbreak began to pick up. What happens when you’re infected with SARS-CoV-2? In people, SARS-CoV-2 causes a disease dubbed COVID-19 by the World Health Organization (WHO). As the US Centers for Disease Control and Prevention (CDC) points out, the ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease. What are the symptoms? COVID-19 is a disease with a range of symptoms and severities, and we are still learning about the full spectrum. So far, it seems to span from mild or potentially asymptomatic cases all the way to moderate pneumonia, severe pneumonia, respiratory distress, organ failure and, for some, death. Many cases start out with fever, fatigue and mild respiratory symptoms, like a dry cough. Most cases don’t get much worse, but some do progress into a serious illness. According to data from nearly 56,000 laboratory-confirmed COVID-19 patients in China, the rundown of common symptoms went as follows: 88 percent had a fever 68 percent had a dry cough 38 percent had fatigue 33 percent coughed up phlegm 19 percent had shortness of breath 15 percent had joint or muscle pain 14 percent had a sore throat 14 percent headache 11 percent had chills 5 percent had nausea or vomiting 5 percent had nasal congestion 4 percent had diarrhea Less than one percent coughed up blood or blood-stained mucus Less than one percent had watery eyes That data was published in a report by a band of international health experts assembled by the WHO and Chinese officials (called the WHO-China Joint mission), who toured the country for a few weeks in February to assess the outbreak and response efforts.
  • 6. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 6/27 How severe is the infection? Most people infected will have a mild illness and recover completely in two weeks. In an epidemiological study of 44,672 confirmed cases in China, authored by an emergency response team of epidemiologists and published by the Chinese CDC, researchers reported that about 81 percent of cases were considered mild. The researchers defined mild cases as those ranging from the slightest symptoms to mild pneumonia. None of the mild cases were fatal; all recovered. Otherwise, about 14 percent were considered severe, which was defined as cases with difficult or labored breathing, an increased rate of breathing, and decreased blood oxygen levels. None of the severe cases were fatal; all recovered. Nearly 5 percent of cases were considered critical. These cases included respiratory failure, septic shock, and/or multiple organ dysfunction or failure. About half of these patients died. Finally, 257 cases (0.6 percent) lacked severity data. The overall fatality rate in the patients examined was 2.3 percent. Who is most at risk of getting critically ill and dying? Your risk of becoming severely ill and dying increases with age and underlying health conditions. In the group of 44,672 cases discussed above, the highest fatality rates were among those aged 60 and above. People aged 60 to 69 had a fatality rate of 3.6 percent. The 70 to 79 age group had a fatality rate of about 8 percent, and those 80 or older had a fatality rate of nearly 15 percent. Additionally, the researchers had information about other health conditions for 20,812 of the 44,672 patients. Of those with additional medical information available, 15,536 said they had no underlying health conditions. The fatality rate among that group was 0.9 percent.
  • 7. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 7/27 The fatality rates were much higher among the remaining 5,279 patients who reported some underlying health conditions. Those who reported cardiovascular disease had a fatality rate of 10.5 percent. For patients with diabetes, the fatality rate was 7.3 percent. Patients with chronic respiratory disease had a rate of 6.3 percent. Patients with high blood pressure had a fatality rate of 6.0 percent and cancer patients had a rate of 5.6 percent. Puzzlingly, men had a higher fatality rate than women. In the study, 2.8 percent of adult male patients died compared with a 1.7 percent fatality rate among female patients. Are men more at risk? In multiple studies, researchers have noted higher case numbers in men than in women. The WHO Joint Mission report found that men made up 51 percent of cases. Another study of 1,099 patients found that men made up 58 percent of cases. So far, it is unclear if these numbers are real or if they would even out if researchers looked at larger numbers of cases. It’s also unclear if this bias may reflect differences in exposure rates, underlying health conditions, or smoking rates that may make men more susceptible. That said, sex differences have been seen in illnesses caused by SARS-CoV-2’s relatives, SARS-CoV and MERS-CoV. There is some preliminary research looking into this in mice. Some findings suggest that there may be a protective effect from the activity of the female hormone estrogen. Other research has also suggested that genes found on the X chromosome that are involved in modulating immune responses to viruses may also serve to better protect genetically female people, who have two X chromosomes, compared with genetic males, who have only one X chromosome. Enlarge / Graph showing the percentage of cases by age group (blue) and the fatality rates within each age group (orange). China CDC
  • 8. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 8/27 Are children less at risk? Yes, it appears so. In all of the studies and data so far, children make up tiny fractions of the cases and have very few reported deaths. In the 44,672 cases examined by the Chinese CDC, less than one percent were in children ages 0 to 9 years old. None of those cases was fatal. Similar findings have been reported in other studies. The WHO-China Joint Mission report also noted that children appear largely unscathed in this epidemic, writing, “disease in children appears to be relatively rare and mild.” From the data so far, they report that “infected children have largely been identified through contact tracing in households of adults.” An unpublished, un-peer-reviewed study of 391 cases in Shenzhen, China, seems to support that observation. It noted that within households, children appeared just as likely to get infected as adults, but they had milder cases. The study was posted March 4 on a medical preprint server. Still, as the Joint Mission report noted, given the data available, it is not possible to determine the extent of infection among children and what role that plays in driving the spread of disease and the epidemic overall. “Of note,” the report went on, “people interviewed by the Joint Mission Team could not recall episodes in which transmission occurred from a child to an adult.” How long does COVID-19 last? On average, it takes five to six days from the day you are infected with SARS-CoV-2 until you develop symptoms of COVID-19. This pre-symptomatic period—also known as "incubation"—can range from one to 14 days. From there, those with mild disease tend to recover in about two weeks, while those with more severe cases can take three to six weeks to recover, according to WHO Director-General Dr. Tedros Adhanom Ghebreyesus, who goes by Dr. Tedros. How many people die from the infection? This is a difficult question to answer. The bottom line is that we don’t really know. Case fatality rates (CFR)—that is, the number of infected people who will die from the infection—are simply calculated by dividing the number of dead by the number of recovered plus dead. The CFRs you’ve probably seen so far have likely been a crude version of this: deaths divided by total cases. One problem with these crude calculations is that the cases we’re counting aren’t all resolved. Some of the patients who are currently sick may later go on to die. In that situation, the patients' cases are counted, but their deaths are not (yet). This skews the current calculation to make the CFR look artificially low. But a much larger concern is that we are undercounting the number of cases overall. Because most of the COVID-19 cases that we know about are mild, health experts suspect that many more infected people have not presented themselves to healthcare providers to be tested. They may have mistaken their COVID-19 case for a common cold or didn’t notice it at all. In areas hard hit by COVID-19, there may not have been enough testing capacity to detect all of the mild cases. If a large number of mild cases are being missed in the total case count, it could make the CFR look artificially high.
  • 9. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 9/27 JUMP TO END PAGE 1 OF 3 The best way to clear up this uncertainty is to wait until one of the local outbreaks is completely over and then to do blood tests on the general population to see how many people were infected. Those blood tests would look for antibodies that target SARS-CoV-2. (Antibodies are Y-shaped proteins that the immune system makes to help identify and attack pathogens and other unfriendly invaders.) The presence of antibodies against a specific germ in a person’s blood indicates that the person has been exposed to that germ, either through infection or immunization. Screening the general population for SARS-CoV-2 antibodies will give a clearer picture of how many people were actually infected— regardless of whether they were symptomatic or diagnosed while sick. That number can then be used to calculate an accurate CFR. So far, some preliminary population screening for COVID-19 infections has been done in China, specifically in Guangdong province. Screening of 320,000 people who went to a fever clinic suggested that we may not be missing a vast number of mild cases. This in turn suggests that the CFRs we are calculating now are not wildly higher than they should be. However, experts still suspect that many mild cases are going unreported, and many still anticipate that the true CFR will be lower than what we are calculating now. Beyond getting the basic number of cases and deaths right, CFRs are also tricky because they can vary by population, time, and place. We’ve already noted above that the CFR increases in patient populations based on age, gender, and underlying health. But as time goes on, healthcare providers will get collectively better at identifying and treating patients, thereby lowering the CFR. Complicating these statistics further, the quality of healthcare differs from place to place. The CFR in a resource-poor hospital may be higher than that in a resource-rich hospital. Additionally, health systems overwhelmed in an outbreak may not be able to provide optimal care for every patient, artificially increasing the CFR in those places. This seems to be what we’ve seen in China so far. In the WHO-China Joint Mission report, the experts noted that in Wuhan—where the outbreak began and where health systems have been crushed by the number of cases—the CFR was a whopping 5.8 percent. The rest of China at the time had a CFR of 0.7 percent. As of March 5, there were about 13,000 cases and 400 deaths reported outside of China’s Hubei Province (where Wuhan is located). A crude calculation puts the CFR around 3 percent, but this calculation will likely drift throughout the outbreak. We will update the current crude CFR periodically. How does COVID-19 compare with seasonal flu in terms of symptoms and deaths?
  • 10. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 10/27 Most cases of COVID-19 are mild and may feel similar to the seasonal flu before a person recovers. Though the case fatality rate is not yet clear for COVID-19 (as noted above), it so far appears to be significantly higher than the CFRs seen from seasonal flu in the US. Overall CFRs for COVID-19 have hovered around 2 percent to 3 percent during the outbreak. As reported by Kaiser Health News, Christopher Mores, a global health professor at George Washington University, calculated the average 10-year mortality rate for flu in the US at 0.1 percent, based on CDC data. Many experts use this figure, including Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. Likewise, WHO Director-General Dr. Tedros noted in a recent statement that “seasonal flu generally kills far fewer than one percent of those infected.” Still, a lower CFR doesn’t mean a low death toll. So far this flu season, the CDC estimates that up to 45 million Americans have been infected, hospitalizing up to 560,000 and killing 46,000. Influenza remains a leading cause of death in the US. How does SARS-CoV-2 spread? [Updated 3/12/2020] SARS-CoV-2 spreads mainly in respiratory droplets—tiny, germ-toting globs that are launched from the mouth or nose when you breathe heavily, talk, cough, or sneeze. Published data suggests that a single sneeze can unleash 40,000 droplets between 0.5–12 micrometers in diameter. Once airborne, these fall rapidly onto the ground and typically don’t land more than one meter away. If any droplets containing SARS-CoV-2 land on a nearby person and gain access to the eyes, nose, or mouth—or are delivered there by a germy hand—that person can get infected. If droplets containing SARS-CoV-2 land on surfaces, they can get picked up by others who can then contract the infection. According to epidemiologist Maria Van Kerkhove, an outbreak expert at the WHO, SARS-CoV-2 appears to be like its relative, SARS-CoV, in that surface contamination does seem to play a role in the epidemic. It is unclear how long SARS-CoV-2 can survive on any given surface. A recent review published in The Journal of Hospital Infection suggested that human-infecting coronaviruses in general may be able to survive on surfaces for up to nine days. A new non-peer-reviewed, unpublished study led by researchers at the US National Institutes of Health suggests that SARS-CoV-2 can last for hours to up to three days on surfaces, lasting longest on plastic and steel surfaces. The study was posted on a medical pre-print server March 10. Likewise, the WHO says SARS-CoV-2 may survive on surfaces for anywhere from a few hours to several days. The organization also notes that survival will depend on environmental factors, such as temperature, humidity, and the type of surface. SARS-CoV-2 is not thought to be transmitted in air, according to available data. However, the pre-print study by NIH researchers suggests that it may survive in aerosols for up to three hours. Regardless of where it is, as Dr. Van Kerkhove noted, SARS-CoV-2 is quickly killed by disinfecting agents. As the review of coronavirus surface survival reported, the viruses are “efficiently inactivated
  • 11. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 11/27 by surface disinfection procedures with 62–71 percent ethanol, 0.5 percent hydrogen peroxide, or 0.1 percent sodium hypochlorite (bleach) within 1 minute.” Last, genetic material from SARS-CoV-2 does seem to be shed in some patients' feces—potentially in up to 30 percent of patients, according to the report by the WHO-China Joint Mission. A recent study in JAMA also found the virus lurking in toilet bowl and bathroom sink samples. “However,” as the Joint Mission report states, “the fecal-oral route does not appear to be a driver of COVID-19 transmission.” Moreover, routine bathroom cleaning efficiently eliminated the infectious threat, the authors of the JAMA article concluded. How does coronavirus transmission compare with flu? [Update 3/13/2020] In a press briefing on March 3, WHO Director-General Dr. Tedros emphasized that “this virus is not SARS, it’s not MERS, and it’s not influenza. It is a unique virus with unique characteristics.” “Both COVID-19 and influenza cause respiratory disease and spread the same way, via small droplets of fluid from the nose and mouth of someone who is sick,” he said. “However… COVID-19 does not transmit as efficiently as influenza, from the data we have so far. With influenza, people who are infected but not yet sick are major drivers of transmission, which does not appear to be the case for COVID-19.” While media reports have widely circulated fears that asymptomatic people are silently spreading COVID-19 around communities and countries, there is little data to back that up. In fact, asymptomatic cases appear rare and potentially misclassified. Dr. Tedros noted that only 1 percent of cases in China are reported as “asymptomatic.” And of that 1 percent, 75 percent do go on to develop symptoms. Though it is still unclear to what extent infected people may spread the virus before developing symptoms, the WHO still reports that, based on the current data, the biggest drivers of COVID-19 spread are symptomatic people coughing and sneezing. Moreover, the thrust of the epidemic in China has been from the spread of the virus through households and close contacts, not unconnected community members. How contagious is it? [New, 3/9/2020] From current data, the basic reproduction number (R or R naught) for COVID-19 is estimated to be between 2 and 2.5. That is, on average, a single infected person will go on to infect about two other people within a susceptible population. (Because SARS-CoV-2 is new to humans, everyone is assumed to be susceptible.) The R generally is meant to represent an average. In this case, that means some people may infect fewer than two people, while a small proportion may be so-called super spreaders, who shed the virus more efficiently and infect far more than two additional people. A few words of caution about interpreting R : first, as Ars has reported before, R is a complicated calculation, and it isn’t necessarily intrinsic to a pathogen. R also doesn’t indicate how dangerous a disease is or how far it will spread. Last, transmission is context- and time-specific. So far in this outbreak, the WHO has reported that transmission of SARS-CoV-2 has primarily been between people who have had contact with each other, such as family members. Also, transmission 0 0 0 0 0
  • 12. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 12/27 early in a case of COVID-19 (that is, 24 to 48 hours prior to noticeable symptom onset) does not seem to be common. Transmission of SARS-CoV-2 tends to be seen later, when symptoms are apparent, according to the WHO. That’s in contrast to infections such as seasonal flu, which often spreads among unrelated people in the community and often before symptoms are apparent. Seasonal flu has an estimate R of around 1.3. The highly contagious measles has an often-cited R range of 12 to 18, but some calculations have put the number at nearly 60. In terms of the biology of what’s going on during transmission, many details remain unknown. So far, it appears that SARS-CoV-2 gets into human cells by latching onto a receptor molecular on the outside of cells called human angiotensin-converting enzyme 2 (ACE2). These receptors are on cells found primarily in the lower respiratory tract. This may explain why COVID-19 includes fewer upper- respiratory-tract infection symptoms, such as a runny nose, and why SARS-CoV-2 does not seem to spread as readily in the pre-symptomatic period, like influenza. That said, a non-peer-reviewed, unpublished study from Germany involving 9 COVID-19 patients suggested that patients may have high levels of virus in their upper respiratory tracts in the first week or so after symptoms are present. The study was posted March 8 in a medical pre-print server. Can I get SARS-CoV-2 from my pet? Can I give it to my pet? [New, 3/9/2020] Reports from Hong Kong recently raised concern that pets could be victims—or potentially sources— of SARS-CoV-2 after testing on a dog owned by a COVID-19 patient returned a “weak positive” result. Though members of the coronavirus family do infect animals, including dogs, experts at the WHO and the CDC say that there’s no evidence that pets are getting sick from SARS-CoV-2 or transmitting the virus to people. “We don’t believe that this is a major driver of transmission,” WHO epidemiologist Maria Van Kerkhove said in a March 5 press briefing. The dog in Hong Kong is only one case, she noted, and this issue requires much more study to assess its significance. That said, as a general precaution, the CDC does suggest that if you are sick with COVID-19, you should try to “restrict contact with pets and other animals... just like you would around other people” until more information about the virus and its spread are known. The infected pup in Hong Kong is said to have no symptoms but has been placed under quarantine as a precaution. If I get COVID-19, will I then be immune or could I get re- infected? [New, 3/9/2020] The immune responses to a SARS-CoV-2 infection are not well understood, so there’s no clear answer on long-term immunity at this time. There have been reports—such as this one from Japan—of COVID-19 patients who have recovered from the disease only to test positive for the virus again later. However, experts are skeptical that these are truly cases of relapsed infections or reinfections. 0 0
  • 13. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 13/27 The tests used to determine if someone is infected rely on detecting tiny fragments of genetic material from the virus. While this is a good indication that someone has been infected, it doesn’t necessarily indicate that an infection is active or the genetic material is from an intact, infectious viral particle. The tests may simply be picking up genetic remnants of a past infection. How likely am I to get it in normal life? Your risk of exposure depends on where you live and where you’ve recently traveled. In the US, the virus is spreading in certain communities but is not thought to be circulating widely, according to the CDC. Unless there have been a number of cases reported in your area, your risk is considered low. That said, with more testing happening, more cases will appear daily. There are basic things you can do to protect yourself and prepare for cases in your area. What can I do to prevent spread and protect myself? The most important things you can do to protect yourself from COVID-19 (as well as seasonal respiratory infections, like flu and cold) is to practice good, basic hygiene. That is: Wash your hands frequently and thoroughly. Make sure you wash your hands with soap and water for 20 seconds—the time it takes you to hum the Happy Birthday song twice. (One clever Twitter user came up with some alternative tunes for your mitt-scrubbing pleasure.) You should especially wash your hands before eating, after using the restroom, sneezing, coughing, or blowing your nose. If you can’t get to a sink, use a hand sanitizer that has at least 60 percent alcohol, the CDC says. Avoid touching your face, particularly your eyes, nose, and mouth. If you cough or sneeze, cover your face with your elbow or a tissue. If you use a tissue, throw that tissue away promptly, then go wash your hands. Avoid close contact with sick people. If you think someone has a respiratory infection, it’s safest to stay 2 meters away. If you are sick, try to stay home to get better and avoid spreading the infection. Regularly disinfect commonly touched surfaces and items in your house, such as door knobs and counter tops.
  • 14. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 14/27 Should I get a flu vaccine? YES. Getting a flu vaccine will protect you from the seasonal influenza and help prevent you from spreading that virus. Though the vaccine is not 100 percent effective, if you do still get sick with the flu after you are vaccinated, your illness will be milder than if you did not get vaccinated. Getting a flu vaccine is something you should do every year to protect yourself and your community, including those most vulnerable to the infection and those who cannot get vaccinated for medical reasons. But, amid the COVID-19 epidemic, getting a flu shot is even more important. The WHO-recommended method for hand washing. WHO
  • 15. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 15/27 COVID-19 can resemble the symptoms of influenza. If people are vaccinated against the flu and there are few cases of flu in an area, it may make spotting new COVID-19 cases easier. Moreover, healthcare systems around the country are already stretched thin by flu patients who need care and hospitalization each season. In this flu season so far, the CDC estimates that flu is responsible for up to 21 million medical visits and 560,000 hospitalizations. Fewer flu patients means more healthcare resources can be directed to detect and treat COVID-19 cases and thwart the epidemic. When, if ever, should I buy or use a face mask? If you are not sick, do not buy a face mask. If you have one already and you are well, it is not recommended that you use it. Face masks are now in short supply globally, and prices have surged. This is making it difficult for healthcare workers to get the supplies they need to keep themselves safe so they can stay healthy, keep treating patients, and avoid spreading the infection. This tragic situation is exacerbating the outbreak. In a March 3 plea, the WHO called on industry and governments to step up production of masks and help thwart inappropriate buying. “The World Health Organization has warned that severe and mounting disruption to the global supply of personal protective equipment (PPE)—caused by rising demand, panic buying, hoarding and misuse—is putting lives at risk from the new coronavirus and other infectious diseases,” the agency said in a statement. “We can’t stop COVID-19 without protecting health workers first,” WHO Director-General Dr. Tedros said. In addition to putting healthcare workers at risk, wearing a mask may also put you at risk. For one thing, face masks are not entirely effective. Masks still leave your eyes exposed—if rubbed with germy hands, they can be an entry point for viruses. Surgical masks are loose-fitting and leave open the possibility of infectious particles working their way around the mouth. Even the use of N95 respirators, which are designed to protect against respiratory droplets, may not be that helpful to you, since they require proper fitting, and many people do not wear them correctly or consistently. Some experts suggest that when members of the public wear face masks, they tend to fuss with them and touch their faces more. This increases the risk of transferring pathogens from hands to entry points. Also, if you touch the outside surface of a contaminated face mask, you can then contaminate your hand and go on to infect yourself. This negates the purpose of wearing a face mask. Last, some health experts worry that wearing face masks may give people a false sense of security, potentially making them lax about other precautions and protections. The only time experts recommend that members of the public wear a mask is if they are caring for a sick person or are already sick and showing signs of COVID-19. In that case, wearing a mask could reduce the risk that you will spread the infection to others. Otherwise, masks should be reserved for healthcare workers.
  • 16. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 16/27 Should I avoid large gatherings and travel? [Updated 3/13/2020] Yes. If you live in the US, experts say that now is the time for social distancing measures—that is, putting distance between you and other people as much as possible. Avoid gatherings, unnecessary outings, and any unnecessary travel. If you can work from home, do so. School systems are already starting to close in many places. If yours hasn’t yet, start making plans of what you’ll do if or when it does. If you need to go to the doctor, call ahead and ask about tele-health options. If you must go out or travel, try to stay 2 meters (about 6 feet) away from people. Practice good hygiene: wash your hands with soap and water frequently, cough and sneeze into your elbow, avoid touching your face. Social distancing “is not a panacea,” Dr. Michael Ryan, executive director of WHO’s Health Emergencies Program, cautioned in a press briefing March 13. This isn’t going to stop the epidemic, he explained, but it will slow it down and allow health systems to better cope with the burden of mounting COVID-19 cases. Though most cases of COVID-19 are mild, many will require hospitalization. In a study of 44,672 cases in China, around 14 percent needed hospitalization. If a scenario close to this plays out in the US, every hospital bed in the US may be occupied by mid-May, according to some estimates. Social distancing may help avoid or delay that. But ultimately the way to stop the epidemic is for officials to start widespread testing, identify cases, put infected people in isolation, trace their contacts, put them in quarantine, and continue monitoring. So far, that has not been happening in the US. The country’s response has been severely crippled by extremely limited and slow testing. As a country, we are not doing enough testing to know how far SARS-CoV-2 has spread in communities now, let alone to prevent further spread. The worst of the outbreak is yet to come for the US, Dr. Anthony Fauci, director of the NIH’s National Institute of Allergy and Infectious Diseases, said in a Congressional hearing on Wednesday, March 11. "I can say we will see more cases, and things will get worse than they are right now," Fauci said. "How much worse we'll get will depend on our ability to do two things: to contain the influx of people who are infected coming from the outside, and the ability to contain and mitigate within our own country." For those who must travel internationally, the CDC provides risk assessments and travel guidance on its website here. For people outside of the US, in areas where SARS-CoV-2 is not yet known to be circulating, the original response from 3/8/2020 is below: Unfortunately, there is no clear or general answer to the question of travel and attending large gatherings. Like your risk of exposure generally, risk from attending events and traveling depend on where you are and where you are going. Any time you’re faced with such a decision amid this epidemic, you should consider not only your local risk but also whether you will encounter people from high risk areas while traveling to the event
  • 17. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 17/27 FURTHER READING or once you are at it. For local events largely attended by local people in communities where there are no or limited cases, attending is considered low risk. Traveling to or through areas experiencing large clusters of cases will certainly increase your risk of contracting COVID-19. Attending a conference where there will be groups of people from high-risk areas also increases your risk. But of course, these risk assessments only hold up if we have a firm grasp of where the virus is circulating. Right now, we’re not in a good place to assess this, according to Harvard epidemiology professor Marc Lipsitch. “A month ago, it was easier to answer and, I think, a month from now it will be easier to answer,” Lipsitch said in a COVID-19 forum at Harvard on March 2. “Right now, it’s possibly the hardest time to answer.” Earlier, the outbreak was mostly in China’s Hubei Province, so it was easy to recommend travel restrictions to and from there. And a month from now, the virus may be so widespread that traveling doesn’t change your risk much—or it could be contained and it will be clear which places are low or high risk (we can hope). But for now, the virus is scattering around the globe. It’s hard to pin down which places are low and high risk. With new cases popping up continually, the situation in any given place can change at a dizzying pace. For anyone facing criticism of being too cautious, Lipsitch did say that “limiting optional travel makes a lot of sense.” High risk or not, “it’s part of a response to try to slow this down.” What precautions should I take if I do travel? If you must travel, avoid contact with sick people, wash your hands frequently, use hand sanitizer, and avoid touching your face. If you’re traveling by air, avoid layovers in high-risk areas. Do quarantines, isolations, and social-distancing measures work to contain the virus? [New, 3/10/2020] Yes, for the most part. When the epidemic of COVID-19 first exploded out of Wuhan in January, officials in China and other countries began issuing quarantines, imposing social-distancing measures, and setting travel restrictions. China locked down tens of millions of people in late January, for instance. In the Hubei province, where Wuhan is located, officials implemented so called “social distancing measures,” cancelling events and gatherings, closing schools, having people stay at home, and upping sanitation and hygiene measures. Meanwhile, other countries issued travel restriction. The United States, for instance, barred entry of some foreign nationals with recent travel to China. Some public health experts were critical of the moves, calling some of them draconian and ineffective. For
  • 18. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 18/27 Americans on coronavirus cruise ship barred from US after failed quarantine instance, quarantines, which can clumsily round up the sick with the healthy, may not prevent the spread of disease—which we certainly saw on the Diamond Princess cruise ship, quarantined in Japan. And travel restrictions in our highly-connected world are inevitably leaky. But proponents of the policies were quick to argue that the measures were never intended to hermetically seal off cities or countries. Rather, the moves were intended to slow down the spread of disease. This can buy officials time to prepare, help avoid overwhelming healthcare facilities with a burst of cases, and in the end, lower the overall case counts in an epidemic. According to the latest data, those proponents of the measures were, on the whole, correct. In the WHO-China Joint Mission report, the group of experts estimated that China’s massive efforts to contain the virus have “averted or at least delayed hundreds of thousands of COVID-19 cases in the country.” This, in turn, had helped blunt the impact on the rest of the globe, they add. Further, in a new non-peer-reviewed, unpublished study, an international team of researchers estimated that without the measures, the number of cases in mainland China would have been 67- times higher. And if officials had begun implementing them just one week earlier, cases could have been reduced by 66 percent. If they had implemented them three weeks earlier, cases would have been reduced by 95 percent. The study appeared on a medical pre-print server March 9. Likewise, in another non-peer-reviewed, pre-print study, this one led by epidemiologists at Harvard, researchers estimate that early interventions—quarantines, social distancing, contact tracing, etc.— successfully and dramatically blunted the peak burden of disease in the Chinese city of Guangzhou. In a Twitter thread March 10, one of the coauthors of that study, Harvard epidemiologist Marc Lipsitch, noted that as community spread increases, social distancing—however painful—becomes Enlarge CDC
  • 19. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 19/27 JUMP TO END PAGE 2 OF 3 essential to slowing and minimizing the impact of disease. In the thread, he references a comparison of outbreaks of the 1918 pandemic flu in Philadelphia and St. Louis. In Philadelphia, authorities downplayed the spread of disease and did not issue social- distancing measures quickly. They even went forward with a city-wide parade as the disease spread. St. Louis, on the other hand, quickly implemented social distancing measures within days of the area’s first reported cases. The graph below shows how well things worked out for each city. Enlarge PNAS, Richard J. Hatchett, Carter E. Mecher, and Marc Lipsitch, 2007 How should I prepare for the worst-case scenario? This epidemic is unpredictable, and it is possible that it could begin spreading in your community. That might lead to problems in the supply chain of various foods and goods—such as masks. It might also mean that local authorities will recommend “social distancing” measures, asking that you spend more time at home as events and gatherings get cancelled. Schools may close down for periods to try to stop disease spread. Employers may recommend working from home when possible, and healthcare providers may push the use of tele-health services. In the event you get sick with COVID-19, you will likely face a two-week isolation period at home, unless your illness becomes severe and you require medical care at a hospital.
  • 20. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 20/27 Experts suggest that if you haven’t already, go ahead and start putting together an emergency stash of food and supplies for these scenarios, but do not panic buy and do not hoard. Just pick up a few extra items on your routine shopping trips that will help make sure you don’t run out of food if you’re stuck in your house for two weeks. Stick with shelf-stable items that you’ll use regardless of how this epidemic plays out—things like dried pasta, canned foods, beans, lentils, peanut butter, trail mix, nuts, shelf-stable or powdered milk, coffee, cereal, cooking oil, and other grains. Since it’s unlikely that we will lose power or municipal water, it’s probably safe to stock up on some frozen items you normally eat—and you can skip buying a lot of bottled water. In addition to food, you should think about having some extra supplies of home goods and medicines on hand. If you take prescription medications, try to have extra doses (though this can be difficult to do). Keep your home comfortably stocked with things like toilet paper, tissues, diapers, soap, cleaning products and sanitizers, pet foods, and feminine products. Again, don’t hoard. Just buy a bit extra in case you need to skip a routine shopping trip or two. If things look like they’re going to get really bad in terms of supply-chain issues, you can dash out in the eleventh hour to pick up whatever dairy, produce, meat, or baked goods you can get. The CDC has a detailed list of other items to keep on hand in general emergencies. Should I keep anything in my medicine cabinet for COVID-19? [Updated, 3/16/2020] With most mild to moderate cases involving nonspecific, flu-like symptoms, you may want to make sure you have enough fever-reducer/pain reliever, such as ibuprofen or acetaminophen (see the update below). You might also want to consider keeping over-the-counter treatments for colds around, just because it’s that season. Upper respiratory symptoms like productive coughs and nasal congestion were not common symptoms of COVID-19, but they are sometimes present. Otherwise, there aren’t specific treatments. Update: A note about ibuprofen as well as ACE inhibitors, angiotensin II type-I receptor blockers (ARBs), and other anti-inflammatory drugs that may be used to treat diabetes and cardiovascular disease: There have been hypotheses and speculation that these drugs could increase people’s risk of being infected with SARS-CoV-2 or make COVID-19 cases more severe. Some researchers have hypothesized that this may be the case because these drugs could increase a person’s amount of ACE2 receptors. These are molecules on the outside of some human cells that SARS-CoV-2 can latch onto, allowing the virus to get into those cells and replicate. Some officials have even suggested that COVID-19 patients avoid taking ibuprofen for fever and pain and stick with acetaminophen (Tylenol). So far, there is not sufficient evidence to support the hypothesis or the clinical recommendation. Some medical experts, including the European Society of Cardiology, have even made a point to
  • 21. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 21/27 FURTHER READING FDA, FTC slam 7 companies selling bogus COVID-19 cures release statements urging patients to continue taking their prescription medications. Some experts have noted that favoring acetaminophen to treat COVID-19, out of an abundance of caution, isn’t a terrible idea. But people should follow dosages carefully since the drug can be toxic to the liver. We'll update this section as more information is available. Can X home remedy or product prevent, treat, or cure COVID-19? [New, 3/11/2020] A word of caution about misinformation and fraudulent claims. Like any pressing health topic, there will be plenty of people attempting to exploit the situation for personal gain, whether it be money or status (particularly on social media). The Internet is rife with false information about SARS-CoV-2 and COVID-19 as well as bogus products and strategies to combat them. This will likely intensify as the pandemic escalates in the United States. As the FDA noted in an enforcement action this week: there are currently no vaccines or drugs approved to treat or prevent COVID-19. “Although there are investigational COVID-19 vaccines and treatments under development, these investigational products are in the early stages of product development and have not yet been fully tested for safety or effectiveness,” the agency says. So, no, eating lots of garlic and huffing essential oils won’t ward off COVID-19. Spraying colloidal silver up your nose won’t stop SARS-CoV-2 from invading. Getting vaccines that protect against other pathogens—such as the influenza virus or bacteria that cause pneumonia, such as Streptococcus pneumoniae (pneumococcus)—are also not going to prevent COVID-19. (For more examples, the WHO has a site dedicated to myth busting.) These fraudulent claims waste money, give people a false sense of security, delay actual medical care and treatments, and can sometimes be outright dangerous. Should I go to a doctor if I think I have COVID-19? If you believe you have COVID-19, the CDC advises you should call your healthcare provider—do not make an unannounced office visit. Your healthcare provider, with the help of your state’s health department and the CDC, can determine if you should come in and get tested. Obvious reasons to test include the presence of COVID-19-like symptoms, having had contact with someone known to be infected, living in a place where transmission is occurring, or if you have recently traveled to a place where transmission is occurring. If you do have COVID-19, getting tested can help local health departments track the virus’ spread and identify contacts who may have also been exposed. Once your case is confirmed, your healthcare provider and local health department can work with you to monitor and manage your health and assess when you’re no longer at risk of spreading the infection.
  • 22. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 22/27 But it’s important that you call ahead before going to a healthcare provider if you’re concerned you have COVID-19. This will help determine if you can and should be tested and provide your healthcare provider with a chance to prepare the office so you will not potentially expose people in the facility or patients in the waiting room to the virus. If a healthcare provider has you come in for a test, the CDC recommends wearing a mask and, as always, practicing good hygiene. When should I seek emergency care? If you have a confirmed case of COVID-19 or if you have a suspected case and your condition worsens and you have trouble breathing, call your doctor immediately to seek prompt medical care. If your condition becomes an emergency, call 911 and inform them that you may have COVID-19. Wear a mask if possible when emergency responders arrive. Is the US healthcare system ready for this? As experts at the WHO have repeatedly warned, COVID-19 can put enormous strain on healthcare systems. For weeks, they have been advising for countries to get ready and have a plan. So far, there have been worrying signs that the US healthcare system has not heeded this warning. Last week, news broke of a whistleblower allegation that the Department of Health and Human Services sent dozens of untrained employees without protective gear to help manage repatriated citizens at high risk of COVID-19 and under quarantine. On March 5, The New York Times reported that nurses in Washington and California—where SARS- CoV-2 is circulating in some communities—have had to beg for masks and have been pulled from quarantines to treat patients. In a survey of more than 6,500 nurses in 48 states by National Nurses United, a nationwide union of nurses, only 29 percent reported that their hospitals had plans in place to isolate possible COVID-19 cases. Only 44 percent said their employer had provided them with guidance on how to respond to potential COVID-19 cases, and only 63 percent said they had access to N95 respirators. There have also been anecdotal reports from Washington and California of people trying to get tested for the virus but being told that there were no tests available. What are the problems with testing in the US? Testing for COVID-19 in the US has been a tragic debacle. The CDC was tasked with coming up with a diagnostic test to detect SARS-CoV-2 in respiratory samples from patients. The agency developed an RT-PCR test for the new virus and sent testing kits beginning in early February to states. But, as the agency notes on its website, “shortly thereafter performance issues were identified related to a problem in the manufacturing of one of the reagents which led to laboratories not being able to verify the test performance.” While the CDC has been mum about what exactly went wrong, a report in Science suggests that the problem was with a negative control in the kit—a sample designed to produce a negative test result. Should that control return a positive result, it would render test results uninterpretable, since there's
  • 23. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 23/27 no way of knowing if positive results are actually due to the presence of the virus. A report in Axios suggests that the problem may have been due to contamination. The problem took the agency weeks to resolve, and many states weren’t able to ramp up testing until the end of February and start of March. “This has not gone as smoothly as we would have liked,” Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, said in a press briefing February 28. The testing snag cost the country precious time in detecting imported cases, isolating them, and tracing their contacts—critical steps needed to contain the virus. Now, in early March, things are improving. The CDC has worked out the problem with its tests, the FDA has loosened regulations on who can design their own tests, and commercial tests are coming online to provide additional kits to states. Unsurprisingly, in the first few days of increased testing capacity, the number of confirmed cases in the US exploded. ***Current cases in the US [Updated, 3/17/2020]*** As of March 17 at 3pm, there have been more than 5,700 cases detected nationwide and at least 94 deaths. With testing for COVID-19 in the US severely delayed and still dangerously limited, the number of actual cases is expected to be much higher. Now, 49 states, the District of Columbia, Puerto Rico, Guam, and the US Virgin Islands are reporting cases. West Virginia Is the only state that has yet to report a case. Here is the latest map from the CDC on March 16 showing affected states, with a color gradient indicating case ranges in each state. Note that the CDC data sometimes lags behind some case reporting by state and local health departments. This map is sometimes missing cases and states, but you can get a general idea of the country’s situations. Generally, for a more up-to-date reference, you can check out the global COVID-19 dashboard, put together by researchers at Johns Hopkins University.
  • 24. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 24/27 The three states hardest hit are Washington, California, and New York. Washington state is currently reporting 904 cases and 48 deaths. The state reported the first case in the whole of the United States back in January. A Seattle-area man in his 30s developed symptoms after returning from a trip to the area around Wuhan, China, where the outbreak began. The current outbreak in the state may link back to that initial case, according to preliminary genetic analyses. New York state is reporting 1,374 cases and 12 deaths. Of the cases, 644 are in New York City and 380 are from Westchester County, a suburb of New York City that has experienced a large outbreak. On March 14, New York City Mayor Bill de Blasio announced the state’s first death in an elderly woman with advanced emphysema. “We all have a part to play here,” he said in the announcement. “I ask every New Yorker to do their part and take the necessary precautionary measures to protect the people most at risk.” California is reporting 472 cases and 11 deaths. The state has housed hundreds of quarantined citizens repatriated from China and passengers from two coronavirus-stricken cruise ships. What could happen if healthcare facilities become overwhelmed? If the situation in the US or in certain communities gets out of hand—and it’s not at all clear if this will happen—hospitals and healthcare facilities may not be able to handle the number of COVID-19 patients seeking care. This could lead to suboptimal care for those patients, potentially increasing the case fatality rate in the country. Enlarge CDC
  • 25. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 25/27 If healthcare systems are overwhelmed, the severe and critical cases will likely get priority, potentially allowing mild cases to go undetected and untreated. This could in turn allow the virus to keep spreading. Again, it is unclear if this will happen. It is a worst-case scenario that can, in part, be avoided if individuals do their part to stop the spread of the disease with hygiene recommendations and mitigation efforts such as social distancing. When will all of this be over in the US? No one knows. Such epidemics are extremely unpredictable, but experts expect that COVID-19 will be with us for at least the coming weeks and months. Will SARS-CoV-2 die down in the summer? So far, we have no evidence that SARS-CoV-2 will be stifled by warming temperatures, WHO epidemiologist Maria Van Kerkhove says. It’s unclear exactly why influenza and other respiratory viruses tend to peak in colder months. Some evidence suggests that the lower temperatures and lower humidity may help viruses spread. But we don't know if that's true for this coronavirus. Will it become a seasonal infection? This is also unknown, but some epidemiologists—including Harvard’s Marc Lipsitch—suggest that SARS-CoV-2 could be with us indefinitely and that we will eventually see it return in seasonal waves. What about treatments and vaccines? Since the epidemic began in January, researchers have rushed to start clinical trials and begun developing vaccine candidates. There are now dozens of vaccine efforts underway. The National Institute of Allergy and Infectious Diseases at the National Institutes of Health has partnered with biotechnology company Moderna to test a vaccine candidate based on messenger RNA that will cause an individual's cells to produce a viral protein without an infection. An early clinical trial in people is expected to start in the coming weeks. If it is successful, a usable vaccine will still take at least a year and a half, according to NIAD’s director, Dr. Fauci—and that is a very optimistic estimate. Meanwhile, researchers and biotech companies are also working on treatments for COVID-19. On February 25, the NIH announced that a clinical trial has begun to test whether an experimental antiviral drug called remdesivir can help COVID-19 patients hospitalized in Nebraska Medical Center (UNMC) in Omaha. Researchers are also working on plasma-derived treatments, which have some positive anecdotal reports. The basic idea behind plasma therapy is to harvest antibodies against SARS-CoV-2 from the blood plasma of infected patients after they’ve recovered. Those collected antibodies can then be injected into newly infected patients, where they could bolster immune responses, potentially
  • 26. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 26/27 READER COMMENTS 2655 SHARE THIS STORY BETH MOLE Beth is Ars Technica’s health reporter. She’s interested in biomedical research, infectious disease, health policy and law, and has a Ph.D. in microbiology. EMAIL beth.mole@arstechnica.com // TWITTER @BethMarieMole ← PREVIOUS STORY NEXT STORY → Powered by improving outcomes and shortening recovery times. On March 4, Takeda Pharmaceutical Company announced that it is beginning work on a plasma-derived therapy for COVID-19. Teach the Controversy: Dowsing Ars Technica's John Timmer explains why dowsing (often called divining or witching) is nothing more than pseudoscience. + More videos Teach the Controversy: Dowsing Teach the Conspiracy: GMOs How Does That Work?: Rising sea levels T h th Related Stories Sponsored Stories
  • 27. 3/18/2020 Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/17] | Ars Technica https://arstechnica.com/science/2020/03/dont-panic-the-comprehensive-ars-technica-guide-to-the-coronavirus/ 27/27 SpaceX launches its Starlink satellites, but misses another landing [Updated] Reputable sites swept up in FB’s latest coronavirus-minded spam cleanse [Updated] A tech bro opts for a digital afterlife in first trailer for Amazon’s Upload Buzz Aldrin has some advice for Americans in quarantine LG’s new consumer 2020 OLED TVs will cost up to $6,000 Inside the model that may be making US, UK rethink coronavirus control Amazon hiring 100,000 warehouse workers amid coronavirus boom Study ranks the privacy of major browsers. Here are the findings STORE SUBSCRIBE ABOUT US RSS FEEDS VIEW MOBILE SITE CONTACT US STAFF ADVERTISE WITH US REPRINTS NEWSLETTER SIGNUP Join the Ars Orbital Transmission mailing list to get weekly updates delivered to your inbox. SIGN ME UP → CNMN Collection WIRED Media Group © 2020 Condé Nast. All rights reserved. Use of and/or registration on any portion of this site constitutes acceptance of our User Agreement (updated 1/1/20) and Privacy Policy and Cookie Statement (updated 1/1/20) and Ars Technica Addendum (effective 8/21/2018). Ars may earn compensation on sales from links on this site. Read our affiliate link policy. Your California Privacy Rights | Cookie Settings The material on this site may not be reproduced, distributed, transmitted, cached or otherwise used, except with the prior written permission of Condé Nast. Ad Choices Today on Ars