[Originally published: January 23, 2020. Updated: April 7, 2020.]
COVID-19 is changing daily life in the United States as SARS-CoV-2, the new virus responsible for spreading the disease, continues to sweep across the country. The U.S., which declared a national emergency in mid-March, now has the most detected cases in the world. Americans are still adjusting to strict guidelines urging them to stay home, avoid unnecessary travel, and stay 6 feet away from other people.
In early March, the World Health Organization (WHO) declared COVID-19 a pandemic—a disease outbreak occurring over a wide geographic area and affecting an exceptionally high proportion of the population. According to the WHO, there are almost 1.3 million confirmed cases of people with COVID-19 and almost 73,000 people have died from the disease—a death toll that has far surpassed that of the severe acute respiratory syndrome (SARS) epidemic that occurred in 2002 and 2003. (While some news sources report different numbers, the WHO provides official counts of confirmed cases once a day.)
In the U.S., the numbers are multiplying, as different parts of the country experience different levels of COVID-19 activity. All 50 states have reported community spread (meaning the source of infection is unknown), and there have been large clusters in certain areas of the country. The Centers for Disease Control and Prevention (CDC) currently provides a rough picture of the outbreak in the U.S. here, currently putting the total confirmed and presumptive cases at almost 375,000, with more than 12,000 deaths, but data provided by state public health departments should be considered the most up to date, according to the agency.
SARS-CoV-2 is a virus that scientists haven’t seen before. Like other viruses, it is believed to have started in animals and spread to humans. Animal-to-person spread was suspected after the initial outbreak in December among people who had a link to a large seafood and live animal market in Wuhan, China.
Scientists and public health officials are working as quickly as possible to find answers to key questions about the severity of the disease and its transmission. They are investigating treatments and a potential vaccine for the disease.
Below is a list of five things you should know about the coronavirus outbreak.
1. What we know about COVID-19 is changing rapidly
What we do know about coronaviruses is that they cause respiratory tract illnesses that range from the common cold to such potentially deadly illnesses as SARS, a global epidemic that killed almost 800 people. 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 the response to the new disease is being adapted from existing guidance developed in anticipation of an influenza pandemic).
According to the CDC, reported COVID-19 illnesses have ranged from very mild (with no reported symptoms in some cases) to severe, including illness resulting in death. People ages 65 and older, those who living in a nursing home or long-term care facility, and people of all ages with underlying health conditions seem to be at higher risk of developing serious illness. But doctors are still working to develop a complete clinical picture of COVID-19, as evidenced by a recent CDC report noting that 20% of those who have been hospitalized for the disease in the U.S. are younger adults (between 20 and 44 years old).
“I think there are two main questions,” says Richard Martinello, MD, a Yale Medicine infectious diseases specialist and medical director of infection prevention at Yale New Haven Health. “First, we need to know how this virus is transmitted between people so we can be more precise in our efforts to stop its spread. Data is needed not only to better understand when those who become ill shed the virus, but also which body fluids contain the virus and how those may contaminate surfaces and even the air surrounding them,” says Dr. Martinello. “Second, there needs to be a better understanding of the pathogenesis of the infection and resulting inflammatory response, so that knowledge can drive the development of therapeutic and preventive medications.”
More information is becoming available. The American Academy of Otolaryngology has called for adding anosmia (loss of smell) to a list of screening tools for COVID-19, and while evidence is still preliminary, the WHO says it is probing a possible link between the disease and the symptom.
Meanwhile, a letter to the editor published in The New England Journal of Medicine in mid-March showed the virus that causes COVID-19 may be stable for several hours in aerosols and for several hours to days on surfaces. Scientists from National Institutes of Health (NIH), CDC, UCLA, and Princeton University who participated in the analysis found SARS-CoV-2 was detectable in aerosols for up to three hours, copper up to four hours, cardboard up to 24 hours, and plastic and stainless steel up to two to three days. While there is much to learn, scientists involved in the analysis observed that emerging evidence suggests people who are infected might be spreading the virus without recognizing, or prior to recognizing, symptoms, according to the NIH.
But Yale Medicine Infectious Diseases specialist Jaimie Meyer, MD, MS, notes, “A lot of times people will make basic science observations in the research lab, but it takes time for us to figure out how clinically relevant it is. So, we don’t know yet know what this study means for transmissibility. Until we understand more about the granular details of how SARS-CoV-2 passes from person to person, public health dictates that people maintain social distancing, wash hands, and frequently disinfect high-touch surfaces."
2. Strict measures are critical for slowing the disease
While no one knows for sure how the situation will progress around COVID-19, studies of influenza have shown that pandemics begin with an “investigation” phase, followed by “recognition,” “initiation,” and “acceleration” phases, according to the CDC. The peak of illnesses occurs at the end of the acceleration phase (the U.S. is currently in an acceleration phase), and that is followed by deceleration, during which there is a decrease in illnesses. Different parts of the country can be in different phases of the pandemic, and the length of each phase can vary depending, in part, on the public health response.
Efforts right now are aimed at “flattening the curve.” If you map the number of COVID-19 cases over time, the expectation is that it will peak at some point—on a graph this peak would mirror a surge in patients (which could overwhelm hospitals and health care providers, affecting the ability to care for all patients). Flattening the curve would mean there would be fewer patients during that period, and hospitals would be better able to manage the demands of patients who are sick with COVID-19 and other illnesses.
State and local authorities are working to flatten the curve by decreasing chances of exposure for as many people as possible, which means responding with strict measures in some cases, including recommendations to shelter-in-place, avoid travel, and social distancing, which means maintaining a 6-foot physical distance from other people. Guidelines from the White House call for "15 Days to Slow the Spread," a plan that has been extended through the month of April that stresses avoiding social gatherings of more than 10 people; using drive-thru, pick-up, or delivery options instead of eating in restaurants; avoiding discretionary travel or shopping; and staying away from nursing homes and long-term care facilities (as the elderly are at especially high risk for serious complications if they get the virus).
People may be at higher risk of exposure if they visit an area that is experiencing community spread of COVID-19, and those coming from a hard-hit area may contribute to spreading the disease when they travel.
Anyone who must travel should first check the CDC's latest travel advisories, which include advice on precautions for domestic in addition to international travel, as well as any state and local recommendations.
3. Infection prevention is key
There are many things you can do to protect yourself and the people you interact with. As with a cold, a flu vaccine won’t protect people from developing COVID-19. “The best thing you can do at this point is take care of yourself the way you would to prevent yourself from getting the flu,” says Yale Medicine infectious diseases specialist Joseph Vinetz, MD. “You know you can get the flu when people sneeze and cough on you, or when you touch a doorknob. Washing hands—especially before eating and touching your face, and after going to the bathroom—and avoiding other people who have flu-like symptoms are the best strategies at this point.”
The CDC also recommends the following preventive actions:
- Wash hands with soap and water for at least 20 seconds. Dry them thoroughly with an air dryer or clean towel. If soap isn’t available, use a hand sanitizer with at least 60% alcohol.
- Stay home if you’re sick.
- Avoid touching nose, eyes, and mouth. Use a tissue to cover a cough or sneeze, then dispose of it in the trash.
- Use a household wipe or spray to disinfect doorknobs, light switches, desks, keyboards, sinks, toilets, cell phones, and other objects and surfaces that are frequently touched.
- It may also be important to create a household plan of action. You should talk with people who need to be included in your plan, plan ways to care for those who might be at greater risk for serious complications, get to know your neighbors, and make sure you and your family have a household plan that includes ways to care for loved ones if they get sick. This includes planning a way to separate a family member who gets sick from those who are healthy, if the need arises.
- The CDC recommends that people voluntarily wearing cloth face masks in public settings where other social distancing measures are difficult to maintain, including grocery stores and pharmacies, especially if they live in an area of significant community-based transmission. It should be noted that the cloth mask is not meant to protect the wearer from infection. It is instead meant to slow the spread of the virus (if people who have the virus and do not know it wear masks, they help prevent transmitting it unknowingly to others). The CDC advises making face coverings at home from simple materials, and reserving surgical masks and N95 respirators for health care workers and other medical first responders.
While everyone should take precautions, measures may be critical for adults over 65 years old (the risk seems to gradually increase with age starting at age 40, according to the WHO) and those with chronic conditions (such as diabetes, heart disease, and lung disease). People in these categories especially should stock up on household items, groceries, medications, and other supplies in case they need to stay home for an extended period.
4. Experts are working rapidly to find solutions
In the U.S., widely available testing will be important in understanding how the disease is transmitted and the true infection and mortality rates. In addition to COVID-19 testing being done by the CDC, state and local public health labs in all 50 states and the District of Colombia are currently using the CDC's COVID-19 diagnostic tests, although the number of available tests is still limited. Until there can be comprehensive testing for COVID-19, it's difficult to know how many cases have not been identified. "Testing is still very limited in Connecticut," says Yale Medicine infectious disease specialist Manisha Juthani, MD. "This will hopefully change, but testing will have to be prioritized for those that are the sickest."
Meanwhile, scientists are studying the virus closely. “With the new virus in a culture dish, they are looking at the biology and working to make drugs to treat it,” says Dr. Vinetz. There is also a great deal of effort underway to assess drugs in development (and some medications currently available) to determine if they are beneficial for treating patients infected with COVID-19, adds Dr. Martinello.
While no pharmaceutical products have yet been shown to be safe and effective for of COVID-19, a number of existing medicines have been suggested as potential investigational therapies. An important effort is a clinical trial evaluating different potential therapeutics at the University of Nebraska Medical Center in Omaha, the first of which is remdesivir, says Dr. Juthani. Remdesivir is an antiviral treatment that, according to the National Institutes of Health, was previously tested in humans with Ebola virus disease and has shown promise in animal models for treating SARS and Middle Eastern Respiratory Syndrome (MERS), a deadly virus that was first reported in Saudi Arabia in 2012.
In mid-March, the National Institute of Allergy and Infectious Diseases (NIAID) announced the first testing in humans of an experimental vaccine called mRNA-1273 developed by NIAID scientists and their collaborators at the biotechnology company Moderna, Inc. But it could take at least a year before such a vaccine is available. The first trial is testing the vaccine on 45 healthy adult volunteers, ages 18 to 55, over approximately 6 weeks. But it could take at least a year before all the necessary phases of the investigation can be completed to ensure the vaccine is safe and effective enough to make publicly available.
5. If you feel ill, here's what you should do
So far, information shows the severity of COVID-19 infection ranges from very mild (sometimes with no reported symptoms at all) to severe to the point of requiring hospitalization. Symptoms can appear anywhere between 2 to 14 days after exposure, and may include:
- Difficulty breathing
You should call your medical provider for advice if you experience these symptoms, especially if you have been in close contact with a person known to have COVID-19 or live in an area with ongoing spread of the disease.
Most people will have a mild illness and can recover at home without medical care. Seek medical attention immediately if you are at home and 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.
Patients and members of the community can call the Yale Medicine/Yale New Haven Health Call Center at COVID-19 hotline of Yale New Haven Health at 203-688-1700 (toll-free, 833-484-1200) if they have questions.
Be aware of the information and resources that are available to you
Because knowledge about the new virus is evolving rapidly, you can expect information and recommendations to change frequently. Threats like COVID-19 can lead to the circulation of misinformation, so it’s important to trust information only from reputable health organizations and government sources such as the CDC and the WHO. “The public health infrastructure in the U.S. is a critical resource for leading the federal, state, and local response,” Dr. Martinello says.
Yale Medicine doctors are advising anyone who has concerns about COVID-19 exposure or symptoms to call their primary care doctor for instructions. Doctors at Yale Medicine and Yale New Haven Health also are encouraging all patients to sign up for MyChart, a secure online portal that allows patients to manage and receive information about their health, and enables telehealth visits (by phone or video), which is how Yale Medicine specialists currently are delivering most care not related to COVID-19.
Health officials recognize that the outbreak has been stressful for everyone, and this can have serious impacts on mental health. If you, or someone you care about, are feeling overwhelmed with emotions like sadness, depression, or anxiety, or feel like you want to harm yourself or others, call 911, or the Substance Abuse and Mental Health Administration’s Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746. (TTY 1-800-846-8517). You can call the National Domestic Violence Hotline at 1-800-799-7233 (TTY: 1-800-787-3224.)