Coronavirus disease 2019 (COVID-19) is the official name given by the World Health Organization (WHO) to the disease caused by SARS-CoV-2, the new coronavirus that surfaced in Wuhan, China in 2019 and spread around the globe. By March 2020, COVID-19 was so widespread that the WHO characterized it as a global pandemic, a disease outbreak that covers a wide geographic area and affects an exceptionally high proportion of people.
People who have been infected with COVID-19 respond in different ways—some report mild symptoms or no symptoms at all. Others experience severe symptoms, are hospitalized, and even die from the disease.
Efforts to mitigate the disease have included “social distancing,” masks, and stay-at-home mandates. By early 2021, scientists had developed effective vaccines, and countries around the globe were focused on quickly vaccinating as many people as possible. But there was more to learn, especially with the identification of new SARS-CoV-2 variants (new strains based on mutations in the sequence of the genetic code of the original virus). Meanwhile approaches to treating the disease are still evolving.
What are the origins of the novel coronavirus?
Severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, was never seen before it surfaced in December 2019—when it was believed to have passed somehow from an animal to a human at a large seafood and live animal market in Wuhan. (Its origins are still under investigation.) It is one of seven known coronaviruses that cause illnesses that range from the common cold to severe acute respiratory syndrome (SARS), an epidemic that killed almost 800 people in 2002 and 2003.
COVID-19 is the first pandemic known to be caused by the emergence of a new coronavirus. Novel influenza viruses caused four pandemics in the last century, which is why some of the response to the new disease has been adapted from existing guidance developed in anticipation of an influenza pandemic.
How does COVID-19 spread?
The disease is believed to spread among people in the following ways, according to the Centers for Disease Control and Prevention (CDC):
- Through respiratory droplets transmitted in small particles when a person who is infected breathes, coughs, talks, or sneezes. Bystanders may become infected by inhaling respiratory droplets or aerosol particles that contain the virus.
- Touching the eyes, nose, or mouth with hands or fingers that have infectious virus on them. For instance, it is possible to get COVID-19 by touching a contaminated surface or object, and then touching the eyes, nose, or mouth. But according to the CDC, the risk of contracting COVID-19 in this way is low.
People are more likely to get infected through droplets and particles that circulate in the air if they are within 6 feet (2 arm lengths) of an infected individual.
What are the symptoms of COVID-19?
COVID-19 is most contagious during the early phases of illness, before symptoms begin and when symptoms first develop. Symptoms of COVID-19 can appear anytime between two and 14 days after exposure. Many people report one or more of the following symptoms over the course of their disease:
- Fever or chills
- Shortness of breath and difficulty breathing
- Muscle or body aches
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
You should call your medical provider for advice if you have been in close contact with a person known to have COVID-19 or if you live in an area with ongoing spread of the disease and notice these symptoms.
Seek medical attention immediately if you experience emergency warning signs, including difficulty breathing or shortness of breath, persistent pain or pressure in the chest, new confusion or ability to arouse, or bluish lips or face. This list is not inclusive, so consult your medical provider if you notice other concerning symptoms.
Who is at risk for COVID-19 and complications from the disease?
Anyone who may have been exposed to the SARS-CoV-2 is at risk for COVID-19. Experts are still learning about how to predict who will develop severe symptoms that could lead to hospitalization, time in an intensive care unit, or use of a ventilator to help with breathing.
But the risk for complications increases with age. For example, people in their 60s have more risk than those in their 50s. People who are 85 and older are at the highest risk, according to the CDC, which reports that 8 out of 10 deaths from COVID-19 have been reported in people aged 65 and older.
People of all ages with medical conditions are at higher risk for complications, as are people who smoke. The list of conditions includes, but is not limited to, the following:
- Chronic kidney disease
- Chronic lung diseases including COPD, moderate and severe asthma, and cystic fibrosis
- Heart conditions
- HIV infection
- Liver disease
- Obesity and being overweight
- Sickle cell disease
- Solid organ transplant
- Substance use disorders
Though fewer children than adults have gotten sick with COVID-19, there have been cases where children have gotten severely ill and even died. Doctors are concerned about a rare condition called multisystem inflammatory syndrome (MIS-C) in children, a potentially serious inflammatory condition that may develop after SARS-CoV-2 infection.
How is COVID-19 treated?
Researchers continue to study the safety and effectiveness of a number of treatments for COVID-19. Many treatments are still in the early stages of research and some have shown promise, but scientists need more data on their safety and effectiveness.
Several treatments for COVID-19 are currently available. Monoclonal antibodies that specifically target SARS-CoV-2 may be used to treat patients, though they require intravenous administration and must be used early in the course of COVID-19. In December 2021, two oral antiviral drugs, Paxolvid and molnupiravir, received FDA EUAs. Paxlovid was granted FDA approval in May 2023. When taken within five days of the onset of symptoms, these drugs can reduce the risk of hospitalization and death due to COVID-19. The two drugs are authorized for use in people who are at high risk for severe disease. Paxlovid may be used for those age 12 or over, while molnupiravir is only authorized for adult use.
What vaccines are available in the U.S.?
There are three vaccines being used in the U.S.: the Pfizer-BioNTech messenger-RNA (mRNA) vaccine known as Comirnaty, the mRNA Moderna vaccine known as SpikeVax, and a vaccine made by Novavax. The FDA has approved or authorized each of these vaccines for use in the U.S.
- Pfizer-BioNTech vaccine. In April 2023, the FDA announced that the original Pfizer vaccine which had been in use in the U.S. since December 2020 is no longer authorized or approved for use. That original Pfizer vaccine was a monovalent vaccine, which means it was designed to protect against disease caused by only one strain (in this case, the ancestral strain that began the pandemic in early 2020) of the SARS-CoV-2 virus.
In 2021, Pfizer reformulated their vaccine to better protect against new variants of the virus. The new formulation is a bivalent vaccine, meaning it targets two variants of the virus—the ancestral strain and the Omicron BA.4/BA.5 variants. As of April 2023, the bivalent vaccine is the only Pfizer COVID-19 vaccine authorized by the FDA for use in the U.S.
The FDA has authorized use of the Pfizer bivalent vaccine for the following:
- Children between 6 months and 4 years of age:
- Unvaccinated children are eligible for three doses of the bivalent vaccine. The first two doses should be received three weeks apart and the third dose at least eight weeks later.
- Children who have received one dose of the monovalent Pfizer vaccine are eligible for two doses of the bivalent vaccine. The first bivalent dose should be administered three to eight weeks after the monovalent dose, and the second shot should be given at least eight weeks after the second dose.
- Children who have received two doses of the monovalent Pfizer vaccine are eligible for one dose of the bivalent vaccine, which should be given at least eight weeks after receiving the monovalent vaccine.
- Children who have gotten three doses of the monovalent Pfizer vaccine are eligible for a single dose starting eight weeks after receiving the monovalent vaccine.
- People ages 5 and older:
- Unvaccinated people are eligible for a single dose of the bivalent Pfizer vaccine.
- People who have received one or more doses of a monovalent vaccine are eligible to get one dose of the bivalent Pfizer vaccine starting at least eight weeks after receiving a monovalent vaccine.
- People ages 65 years and older who have gotten one dose of a bivalent vaccine are eligible for one dose of the bivalent Pfizer vaccine to be given at least four months after getting the previous bivalent vaccine.
- Immunocompromised people 6 months and older:
- Unvaccinated, immunocompromised people 6 months and older are eligible for three doses of the bivalent Pfizer vaccine.
- Immunocompromised people 6 months and older who have received one dose of the monovalent Pfizer vaccine are eligible for two doses of the bivalent Pfizer vaccine.
- Immunocompromised people 6 months and older who have received two or three doses of the monovalent Pfizer are eligible for one dose of the bivalent Pfizer vaccine.
- People in this group have the option to get an additional shot of a bivalent vaccine to be given at least two months after their last bivalent vaccine. Children 5 years of age and younger who have previously gotten a Pfizer vaccine dose are only eligible for the bivalent Pfizer vaccine. People in this group may also be eligible for additional doses of a bivalent vaccine at the discretion of a health care provider.
- Children between 6 months and 4 years of age:
- Moderna vaccine. As with the Pfizer vaccine, in April 2023 the FDA announced that the original monovalent Moderna vaccine is no longer authorized for use in the U.S. A bivalent vaccine that targets the original strain and Omicron BA.4/BA.5 variants is the only Moderna COVID-19 vaccine authorized for use by the FDA.
The FDA has authorized use of the bivalent Moderna vaccine for the following:
- Children between 6 months and 5 years of age:
- Unvaccinated children are eligible for two doses of the bivalent Moderna vaccine. The second dose should be given four to eight weeks after the first.
- Children who have received one dose of the monovalent Moderna vaccine are eligible for one dose of the bivalent Moderna vaccine. The bivalent dose should be received four to eight weeks after the monovalent vaccine.
- Children who have received two doses of the monovalent Moderna vaccine are eligible for a single dose of the bivalent Moderna vaccine. The bivalent vaccine dose should be given at least eight weeks after getting the monovalent vaccine.
- People ages 6 and older:
- Unvaccinated people are eligible for one dose of the bivalent Moderna vaccine.
- People who have received one or more doses of a monovalent vaccine are eligible for one dose of the bivalent Moderna vaccine starting eight weeks after getting a monovalent vaccine dose.
- People ages 65 and older who have received one dose of a bivalent vaccine are eligible for a single dose of the bivalent Moderna vaccine starting four months after getting the previous dose of a bivalent vaccine.
- Immunocompromised people 6 months and older:
- Unvaccinated, immunocompromised people 6 months and older are eligible for three doses of the bivalent Moderna vaccine.
- Immunocompromised people 6 months and older who have received one dose of the monovalent Moderna vaccine are eligible for two doses of the bivalent Moderna vaccine.
- Immunocompromised people 6 months and older who have received two or three doses of the monovalent Moderna vaccine are eligible for one dose of the bivalent Moderna vaccine.
- People in this group have the option to get an additional shot of a bivalent vaccine to be given at least two months after their last bivalent vaccine. Children between 6 months and 4 years of age who have previously gotten a Moderna vaccine dose are only eligible for the bivalent Moderna vaccine. People in this group may also be eligible for additional doses of a bivalent vaccine at the discretion of a health care provider.
- Children between 6 months and 5 years of age:
- Novavax vaccine. Requires two doses given three to eight weeks apart. In July 2022, the vaccine received an FDA EUA for people 18 years of age and over and in August 2022, the FDA issued an EUA for the vaccine for individuals 12 years of age and older. The CDC says people should consider getting the Novavax vaccine if they are “unable or choose not to get an updated [bivalent] Pfizer-BioNTech or Moderna COVID-19 vaccine.”
- Janssen/Johnson & Johnson vaccine. As of May 7, 2023, Johnson & Johnson’s vaccine is no longer available for use in the U.S.
The Johnson & Johnson vaccine was available for use in people 18 years of age or older under an FDA EUA. The primary series consisted of a single dose of the vaccine. However, in December 2021, the FDA announced evidence suggesting a causal relationship between the Janssen/Johnson & Johnson vaccine and a rare but serious blood clotting disorder called thrombosis with thrombocytopenia (TTS). Because of this, the FDA EUA was changed to says that people who had blood clotting with low platelet counts after receiving the Johnson & Johnson vaccine should not get the Johnson & Johnson vaccine as a booster dose.
Then, in May 2022, the FDA further revised the EUA, limiting the use of the vaccine to certain groups of people due to risk of the rare blood clotting disorder. For most people, the CDC recommends the Pfizer, Moderna, or Novavax vaccine over the Johnson & Johnson one. In some cases, the Johnson & Johnson vaccine may be appropriate. For instance, it may be considered for those ages 18 and over who have had a severe reaction to an mRNA vaccine, wish to receive the Johnson & Johnson vaccine, or would otherwise remain unvaccinated because other vaccines have limited access.
What is the guidance on COVID-19 booster shots?
The CDC recommends that all people who are eligible get vaccinated against COVID-19 and stay up to date with booster shots. The agency’s guidelines for booster shots vary based on age, the amount of time since the initial vaccination or previous booster shot, underlying health conditions, and the type of vaccine.
- Pfizer-BioNTech. As of April 2023, the FDA has authorized an additional dose of the Pfizer bivalent vaccine for people 65 years of age and older and for immunocompromised people ages 5 and older who have already received a single dose of a bivalent COVID-19 vaccine. Immunocompromised people age 5 and over may get additional doses of the Pfizer bivalent vaccine at the discretion of a health care provider.
- Moderna. In April 2023, the FDA authorized an additional dose of Moderna’s bivalent vaccine for people ages 65 and over who have previously received one dose of a bivalent COVID-19 vaccine. Immunocompromised children between 6 months and 5 years of age who have received two doses of the original or bivalent Moderna vaccine are eligible for an additional dose of the bivalent vaccine. The FDA has also authorized an additional dose of the Moderna bivalent vaccine for immunocompromised people 6 years of age and over at least two months after an initial dose of a bivalent vaccine. At the discretion of a health care provider, additional doses of the Moderna bivalent vaccine may be given to immunocompromised people in this age group.
- Novavax. In October 2022, the FDA authorized the Novavax vaccine as a first booster dose for people aged 18 and over. The Novavax vaccine is monovalent, meaning it targets only one strain (the original strain) of the coronavirus. The CDC notes that the Novavax booster is an option for people ages 18 and over who “are unable or unwilling to receive a Pfizer or Moderna updated COVID-19 booster,” have completed their primary COVID-19 vaccine series at least 6 months previously, and have not yet received any other booster shot.
- Johnson & Johnson. The Johnson & Johnson vaccine is no longer available for use in the U.S. The CDC recommends that people who received one or two shots of the Johnson & Johnson vaccine get one dose of the Pfizer or Moderna bivalent COVID-19 vaccine starting two months or longer after their previous shot.
How effective are vaccines against COVID-19?
The original Pfizer-BioNTech and Moderna vaccines were shown in clinical trials to have an overall efficacy of 95% and 94.1%, respectively, against mild to severe COVID-19 caused by the ancestral SARS-CoV-2 strain. The Johnson & Johnson vaccine was shown to have an overall efficacy of 66% efficacy against moderate to severe COVID-19, while the Novavax vaccine was shown to have a 90.4% efficacy against symptomatic COVID-19. People are considered fully vaccinated two weeks after receiving their second shot of the Pfizer and Moderna vaccines and two weeks after receiving the Johnson & Johnson vaccination.
While the vaccines in use in the U.S. protect against severe illness and death, people who have been fully vaccinated can still get COVID-19. This is because none of the vaccines is 100% effective against infection or illness. People who are vaccinated against COVID-19 can also spread the virus to others and should take precautions to avoid spreading the virus. The CDC tracks COVID-19 cases and deaths by vaccination status to learn about virus variants and the effectiveness of COVID-19 vaccines.
Several studies have shown that vaccine effectiveness against SARS-CoV-2 infection and protection against mild, moderate, and severe disease decreases over time. For instance, a study published in the British Medical Journal (BMJ) in October 2022 found that the effectiveness of mRNA COVID-19 vaccines waned over time. The study assessed data from nearly 900,000 adults admitted to hospitals, emergency departments, and urgent care clinics across 10 states.
Evidence also suggests that the vaccines do not work as well against emerging variants, including Omicron variants, because these are able to partially evade the immune response. Because vaccine effectiveness can wane over time and emerging coronavirus variants are capable of partially evading the immune response, Pfizer and Moderna have formulated bivalent mRNA vaccines that target both the original strain of the coronavirus and Omicron BA.4/BA.5 subvariants. Researchers are actively studying the effectiveness of the vaccines against Omicron variants.
While vaccine effectiveness against disease may decline over time in vaccinated people, the COVID-19 vaccines in use in the U.S. still provide good protection against severe disease and death. The CDC recommends that everyone stay “up to date” with COVID-19 vaccinations and boosters to ensure the best protection against COVID-19.
What are virus variants?
Scientists have identified several variants of the original coronavirus strain that causes COVID-19. Some of these variants are known as “variants of concern” because they may be more contagious, cause more severe illness, and/or reduce the relative effectiveness of treatments or vaccines compared to the original COVID-19 strain. Scientists are also concerned that other variants might emerge in the future.
The CDC currently recognizes one variant of concern—Omicron, named based on a letter of the Greek alphabet. In late December 2021, Omicron overtook Delta, another coronavirus variant, as the dominant variant in the U.S. As of late May 2022, the Omicron variant made up an estimated 100% of all cases in the U.S. Scientists have detected several subvariants of Omicron. Some of these subvariants, such as one known as EG.5, also called Eris, have certain mutations that make them more transmissible and better able to evade immunity acquired from vaccination or a previous infection than the original Omicron variant. Scientists are studying recently detected Omicron subvariants to better understand their transmissibility and whether they cause more severe disease.
In early September 2023, the Omicron EG.5 subvariant made up an estimated 21.5% of COVID-19 cases in the U.S., while the FL.1.5.1 subvariant accounted for an estimated 14.5% of cases. Several other Omicron subvariants were circulating as well, including XBB.1.16.6, XBB.1.16, XBB.2.3, HV.1, and XBB.1.16.1. These variants made up an estimated 9.2%, 8.9%, 8.1%, 5.1%, and 5.0% of U.S. cases, respectively. A handful of other Omicron subvariants were also in circulation, though each of them made up only a small percentage of total cases.
In August 2023, the CDC detected a new coronavirus variant known as BA.2.86, informally called Pirola. The variant has a number of mutations not found in previously identified Omicron strains. Researchers are still studying BA.2.86 to determine whether the mutations make it more transmissible or less responsive to treatments than other variants. As of early September 2023, only a small number of cases had been reported in the U.S., though BA.2.86 has also been detected Europe, Canada, and Israel.
Fortunately, research suggests that the one authorized (and two fully approved) COVID-19 vaccines protect against severe illness caused by the known variants, and scientists are monitoring the virus to detect any new variants that appear.
What precautions can I take to avoid COVID-19?
The CDC recommends several preventive measures to protect against getting infected with the coronavirus and reduce the chances of spreading it to others, including:
- Get vaccinated against COVID-19 and stay up to date with booster shots.
- The CDC recommends that people wear the most protective mask that they will wear consistently. To be effective, a mask should be tight fitting, without gaps that allow respiratory droplets to escape or enter the mask. Various types of masks are available including cloth masks, disposable “surgical” masks, and the most protective option, respirators such as N95s or KN95s. This CDC webpage provides details on different types of masks, how to check and improve mask fit, and mask recommendations for children and others.
- Wash hands often with soap and water for at least 20 seconds, especially if you have been in a public place. If soap isn’t available, use a hand sanitizer with at least 60% alcohol.
- Cover coughs and sneezes
- Practice social distancing by staying at least 6 feet away from other people.
- Avoid touching eyes, mouth, or nose unless hands are clean.
- Avoid crowded indoor places and indoor spaces with poor ventilation.
- Avoid close contact with people who have COVID-19. Those who have been in the presence of someone who has a coronavirus infection for 15 minutes or more within a 24-hour period should follow the CDC’s quarantine recommendations.
- Regularly clean and disinfect frequently touched surfaces such as doorknobs, light switches, desks, keyboards, sinks, and other objects and surfaces, especially if someone in the household has tested positive for COVID-19 or is sick.
Testing can help prevent the spread of COVID-19. If someone tests positive for a coronavirus infection, they can take steps to avoid spreading the virus to others such as isolating. Two types of tests are available that can check for a current coronavirus infection.
In February 2022, as the number of Omicron infections declined substantially, the CDC relaxed its guidance around masks, physical distancing, and other preventive measures. The health agency now recommends that people wear a mask when “Community Levels” of COVID-19 are medium or high. The COVID-19 Community Level is determined based on county-level data on the number of new cases, hospital admissions, and the percentage of hospital beds used by COVID-19 patients. The CDC provides a tool to check COVID-19 Community Level in every county in the U.S.
How is Yale Medicine prepared to handle patients with COVID-19?
Yale Medicine Infectious Diseases has an entire team with experience treating both existing and emerging diseases. This team is at the forefront of the latest testing, diagnostic, and treatment approaches.
The Yale Medicine Winchester Center for Lung Disease’s Post-COVID-19 Recovery Program offers pulmonary-focused, multidisciplinary evaluation and care for patients recovering from COVID-19. The program partners with teams taking care of patients in the hospital, as well as community providers to identify patients who have persistent symptoms or appear at risk of developing post-COVID-19 complications.
Yale New Haven Health offers a call center for patients and people in the community who have questions about COVID-19 at 833-ASK-YNHH (833-275-9644).