As coronavirus spreads, many questions and some answers

The rapid spread of the virus that causes COVID-19 continues to spark alarm worldwide. Countries around the world are grappling with surges in confirmed cases, hospitalizations, and deaths. Calls for preventive measures such as social distancing and face coverings to slow the spread of coronavirus have created a new normal in many places. Health care workers and hospitals have ramped up capabilities to care for large numbers of people made seriously ill by COVID-19. Meanwhile, scientists are exploring potential treatments and clinical trials to test new therapies and vaccines are underway.

Below, you'll find answers to common questions all of us are asking. We will be adding new questions and updating answers as reliable information becomes available. Also see our podcasts featuring experts discussing coronavirus and COVID-19.

Symptoms, spread, and other essential information

What is coronavirus and how does it spread? What is COVID-19 and what are the symptoms? How long does coronavirus live on different surfaces? Take a moment to reacquaint yourself with basic information about this virus and the disease it causes.

Social distancing, hand washing, and other preventive measures

By now, many of us are taking steps to protect ourselves from infection. This likely includes frequent handwashing, regularly cleaning frequently touched surfaces, and social distancing. How do each of these measures help slow the spread of this virus, and is there anything else you can do?

If you are at higher risk

Though no one is invulnerable, we've seen that older adults are at increased risk for severe illness or death from COVID-19. Underlying conditions, including heart disease, lung disease, and diabetes, increase risk even further in those who are older. In addition, anyone with an underlying medical condition, regardless of their age, faces increased risk of serious illness.

If you've been exposed, are sick, or are caring for someone with COVID-19

Despite your best efforts, you may be exposed to coronavirus and become ill with COVID-19. Or you may be in a position where you are caring for a loved one with the disease. It's important to know what to do if you find yourself in any of these situations. Stock up with medications and health supplies now, and learn the steps you can take to avoid infecting others in your household and to avoid getting sick yourself if you are caring for someone who is ill.

Treatments for COVID-19: What helps, what doesn't, and what's in the pipeline

While there are no specific treatments for COVID-19 at this time, there are things you can do to feel better if you become ill. In the meantime, researchers around the globe are looking at existing drugs to see if they may be effective against the virus that causes COVID-19, and are working to develop new treatments as well.

Coronavirus and kids:

So far, the vast majority of coronavirus infections have afflicted adults. And when kids are infected, they tend to have milder disease. Still, as a parent, you can't help but worry about the safety of your children. Many parents are also trying to find a balance between answering their children's questions about the pandemic and enforcing health-promoting behaviors and social distancing rules without creating an atmosphere of anxiety. Not to mention keeping kids engaged and entertained with schools closed and playdates cancelled.

Coping with coronavirus:

The news about coronavirus and its impact on our day-to-day lives has been unrelenting. There's reason for concern and it makes good sense to take the pandemic seriously. But it's not good for your mind or your body to be on high alert all the time. Doing so will wear you down emotionally and physically.

New questions and answers

If I get sick with COVID-19, how long until I will feel better?

It depends on how sick you get. Those with mild cases appear to recover within one to two weeks. With severe cases, recovery can take six weeks or more.

Some people may experience longer-term physical, cognitive, and psychological problems. They may alternately improve and worsen over time, and can include a variety of difficulties, from fatigue and trouble concentrating to anxiety, muscle weakness, and continuing shortness of breath.

What needs to happen before we have a vaccine for COVID-19?

A successful COVID-19 vaccine will safely and effectively stimulate the body's immune system to create antibodies that protect against the COVID-19 coronavirus. More than 100 COVID-19 vaccines are currently in various stages of development and testing, and more than one may eventually be approved.

Anti-virus vaccine development traditionally requires the following steps:

  • Pre-clinical testing: Animals are infected with the virus. Scientists study their immune response to see what aspects of the immune response might be critical for protection. Normally, a vaccine is first tested in animals. However, in the setting of a pandemic such as this one, the animal testing stage can be skipped.

  • Phase 1 trials: A vaccine is tested in small groups of people to determine what dose safely and consistently stimulates the immune system. At this stage, scientists don't yet know if the immune response triggered by the vaccine will protect against the virus.

  • Phase 2 trials: The vaccine is given to hundreds or thousands of people. Scientists continue to focus on whether the vaccine is safe and produces a consistent immune response.

  • Phase 3 trials: These trials typically enroll tens of thousands of people. This is the first phase that involves a placebo group. It compares the number of people who get sick in the vaccine group to the number of people who get sick in the placebo group. This is the only phase that can show whether or not the immune response triggered by the vaccine actually protects against infection in the real world.

Some researchers are combining trial phases in an effort to speed up the COVID-19 vaccine development process. In addition, the US government has created Operation WARP Speed, which will identify and support mass production of the most promising vaccines before they have been approved, so that they will be available quickly if they are ultimately found to be safe and effective. It's likely that a COVID-19 vaccine will be available before we know how long that vaccine's protective effect will last.

Who is at highest risk for getting very sick from COVID-19?

The risk of serious illness from COVID-19 increases steadily with age, especially for those with underlying medical problems like chronic bronchitis, emphysema, cardiovascular disease, serious heart conditions, obesity, or diabetes. According to a recent study published in the CDC's Morbidity and Mortality Weekly Report, certain underlying medical conditions may increase the risk of serious COVID-19 for individuals of any age.

The strongest evidence supporting increased risk of serious COVID-19 illness applies to the following conditions:

  • chronic kidney disease

  • COPD (chronic bronchitis or emphysema)

  • obesity (body mass index [BMI] of 30 or higher)

  • immunocompromised state (weakened immune system) from solid organ transplant

  • serious heart conditions, including coronary artery disease, heart failure, and other diseases of the heart muscle

  • sickle cell disease

  • type 2 diabetes.

Conditions that might increase risk of severe COVID-19 illness include:

  • moderate to severe asthma

  • cerebrovascular disease such as stroke

  • cystic fibrosis

  • high blood pressure

  • weakened immune response due to blood or bone marrow transplant, immune deficiencies, HIV or AIDS, use of corticosteroids, or use of other immune-weakening medications

  • any condition or treatment that weakens the immune response (cancer, cancer treatment, organ or bone marrow transplant, immunosuppressant medications, HIV or AIDS)

  • neurologic conditions, such as dementia

  • liver disease

  • pregnancy

  • pulmonary fibrosis (damaged or scarred lung tissue)

  • smoking

  • thalassemia (a blood disorder)

  • type 1 diabetes.

According to the CDC, hospitalizations have been six times higher and deaths 12 times higher among those with reported underlying conditions compared with those who did not have underlying health conditions.

In addition, among COVID-19 cases with known race and ethnicity, 33% were Hispanic, 22% were black, and 1.3% were non-Hispanic American Indian or Alaska Native. These findings suggest that these groups, who account for 18%, 13%, and 0.7% of the US population, respectively, are disproportionately affected by the COVID-19 pandemic.

Everything we are learning underscores the importance of maintaining health-promoting behaviors, even as restrictions begin to ease, especially if you have an underlying medical condition. To reduce your risk of getting sick, continue to stay home when possible, wear a mask and maintain a physical distance of at least six feet when you're around other people, and wash your hands often.

Do the antibodies produced by a person who has been infected with coronavirus protect them from becoming infected again?

Most people who are infected with the COVID-19 virus, whether or not they have symptoms, produce antibodies (proteins that fight infections). New research published in Nature Medicine looked at how long those antibodies last. Results from this small study suggest that levels of one type of antibody dropped sharply within two to three months. However, the decrease in neutralizing antibodies, which target the spike protein on the coronavirus and can help protect against reinfection, was much smaller.

Whether or not the remaining antibodies protect against reinfection, and for how long, is still unclear. It's possible that even low levels of neutralizing antibodies may be able to protect against reinfection. On the other hand, the presence of antibodies does not guarantee immunity.

Another consideration is that antibodies are only one part of the body's immune response. Memory B cells, for example, can quickly generate a strong antibody response to a virus the body has encountered before.

Is dexamethasone effective for treating COVID-19?

A recent report on a clinical trial showed that the corticosteroid drug dexamethasone decreased the risk of dying in very ill hospitalized COVID-19 patients. The report was released prior to publication of the study in a medical journal, which means the research results have not gone through the usual careful review.

Many doctors, including those in the United States, have been treating very ill COVID-19 patients with corticosteroids since the pandemic began. It makes biologic sense for those patients who have developed a hyper-immune response (a cytokine storm) to the viral infection. In these cases, it is the immune system's overreaction that is damaging the lungs and other organs, and too often leading to death.

Dexamethasone and other corticosteroids (prednisone, methylprednisolone) are potent anti-inflammatory drugs. They are readily available and inexpensive.

A key question if dexamethasone is effective for some COVID-19 patients: when should it be started? If you start too soon you blunt the body's natural defense system, and that could allow the virus to thrive. What might make the most biological sense is to give dexamethasone when laboratory studies suggest an immune system in overdrive after the amount of virus in the body has started to decrease.

But we will need more studies beyond this most current report to confirm the drug's effectiveness.

Can people infect pets with the COVID-19 virus?

The virus that causes COVID-19 does appear to spread from people to pets, according to the FDA. Research has found that cats and ferrets are more likely to become infected than dogs.

If you have a pet, do the following to reduce their risk of infection:

  • Avoid letting pets interact with people or animals that do not live in your household.

  • Keep cats indoors when possible to prevent them from interacting with other animals or people.

  • Walk dogs on a leash maintaining at least six feet from other people and animals.

  • Avoid dog parks or public places where a large number of people and dogs gather.

If you become sick with COVID-19, restrict contact with your pets, just like you would around other people. This means you should forgo petting, snuggling, being kissed or licked, and sharing food or bedding with your pet until you are feeling better. When possible, have another member of your household care for your pets while you are sick. If you must care for your pet while you are sick, wash your hands before and after you interact with your pets and wear a face mask.

At present, it is considered unlikely that pets can spread the COVID-19 virus to humans. However, pets can spread other infections that cause illness, including E. coli and Salmonella, so wash your hands thoroughly with soap and water after interacting with your animal companions.

Does vitamin D protect against COVID-19?

There is some evidence to suggest that vitamin D might help protect against becoming infected with, and developing serious symptoms of, COVID-19. We know, for example, that people with low vitamin D levels may be more susceptible to upper respiratory tract infections. One meta-analysis found that people who took vitamin D supplements, particularly those who had low vitamin D levels, were less likely to develop acute respiratory tract infections than those who didn't.

Vitamin D may protect against COVID-19 in two ways. First, it may help boost our bodies' natural defense against viruses and bacteria. Second, it may help prevent an exaggerated inflammatory response, which has been shown to contribute to severe illness in some people with COVID-19.

Our bodies make vitamin D when exposed to sunshine. Five to 10 minutes of sun exposure on some or most days of the week to the arms, legs, or back without sunscreen will enable you to make enough of the vitamin. Good food sources of vitamin D include fatty fish (such as tuna, mackerel, and salmon), foods fortified with vitamin D (such as dairy products, soy milk, and cereals), cheese, and egg yolks.

The recommended dietary dose of vitamin D is 600 IU each day for adults 70 and younger and 800 IU each day for adults over 70. A daily supplement containing 1,000 to 2,000 IU of vitamin D is likely safe for most people. For adults, the risk of harmful effects increases above 4,000 IU per day.

How many COVID-19 infections may have been prevented because of policies designed to slow the spread of the virus?

Large-scale emergency health measures prevented more than 500 million COVID-19 infections in six countries between January and early April 2020, according to a peer-reviewed article published in the journal Nature. The study authors looked at the impact of policies designed to slow the spread of the virus in six countries: the United States, China, South Korea, Italy, Iran, and France. They compared the growth rate of COVID-19 infections in each country before and after the policies — such as travel restrictions; business, school, and restaurant closures; and social distancing — were enacted.

These findings reinforce the importance of continuing to exercise caution and practice health-promoting behaviors as restrictions begin to ease.

What is herd immunity, and could it play a role in stopping the spread of COVID-19?

Herd immunity occurs when enough people become immune to a disease to make its spread unlikely. As a result, the entire community is protected, even those who are not themselves immune. Herd immunity is usually achieved through vaccination, but it can also occur through natural infection.

Based on what we know about the contagiousness of the COVID-19 virus, experts estimate that somewhere between 60% and 70% of the population needs to be immune in order to achieve herd immunity. That's close to 200 million people in the United States, and nearly five billion people worldwide. (As of now, we are nowhere close to the numbers needed to achieve herd immunity.)

Achieving herd immunity through natural infection means many people would become ill and many would die. These risks may fall as we develop effective treatments. However, we still don't know how long people who recover from COVID-19 will remain immune to reinfection.

Ideally, we will achieve herd immunity through a safe vaccine (or vaccines) that will confer lasting immunity.

Are chloroquine/hydroxychloroquine and azithromycin safe and effective for treating COVID-19?

Early reports from China and France suggested that patients with severe symptoms of COVID-19 improved more quickly when given chloroquine or hydroxychloroquine. Some doctors were using a combination of hydroxychloroquine and azithromycin with some positive effects.

Hydroxychloroquine and chloroquine are primarily used to treat malaria and several inflammatory diseases, including lupus and rheumatoid arthritis. Azithromycin is a commonly prescribed antibiotic for strep throat and bacterial pneumonia. Both drugs are inexpensive and readily available.

Hydroxychloroquine and chloroquine have been shown to kill the COVID-19 virus in the laboratory dish. The drugs appear to work through two mechanisms. First, they make it harder for the virus to attach itself to the cell, inhibiting the virus from entering the cell and multiplying within it. Second, if the virus does manage to get inside the cell, the drugs kill it before it can multiply.

Azithromycin is never used for viral infections. However, this antibiotic does have some anti-inflammatory action. There has been speculation, though never proven, that azithromycin may help to dampen an overactive immune response to the COVID-19 infection.

The jury is still out regarding whether these drugs, alone or in combination, can treat COVID-19 viral infection. While recent human studies suggest no benefit and possibly a higher risk of death due to lethal heart rhythm abnormalities, two studies supporting these conclusions have been retracted by the authors because of irregularities in how results were collected and analyzed.

Regarding the effectiveness of hydroxychloroquine alone to prevent coronavirus infection, the results of a clinical trial just published in the New England Journal of Medicine found that it did not prevent infection. However, how this study was conducted has been questioned by some experts.

Where does that leave us? The recommendation has not changed. Chloroquine or hydroxychloroquine with or without azithromycin should not be used to prevent or treat COVID-19 infection unless it is being prescribed in the hospital or as part of a clinical trial.

Clinical trials that were ongoing and about to be started to evaluate the effectiveness of these drugs are resuming.

As I start seeing more friends and family, does it matter whether we meet indoors or outdoors?

As you gradually expand your social circle, you are better off meeting friends and family outdoors. We know that coronavirus spreads when someone breathes in virus that an infected person emits through coughs or sneezes, or when they talk or breathe. A recent study found that in a confined, laboratory setting, droplets containing viral particles can remain afloat for eight to 14 minutes. Smaller infectious viral particles, called aerosols, can drift around in the air even longer.

Outdoors, air currents are more likely to scatter and dilute the virus, making transmission less likely than in a home, office, or other confined space with limited air circulation. Even outdoors, however, it's important to maintain a physical distance of at least six feet and wear a mask, to reduce risk even further.

Coronavirus also spreads when a person touches a contaminated surface and then touches their eyes, nose, or mouth. If you are participating in an outdoor gathering, bring your own foods, drinks, plates, and utensils.