Last review: December 16, 2020
Last revision: December 16,2020
Additional FAQ for professionals are available at the CDC website at https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html
2. What laboratory and imaging findings are characteristic of COVID-19?
3. What proportion of COVID-19 cases are asymptomatic carriers?
Asymptomatic infection seems to be quite common, with reported incidence ranging from 13% to > 50%. However, because asymptomatic people have typically not been tested, the actual incidence is unknown. According to the CDC, the best estimate is that about 35% of people infected with the virus that causes COVID-19 are asymptomatic. Some patients diagnosed during the asymptomatic period progressed to symptomatic disease while others remained without symptoms.
4. What’s the incubation period for COVID-19?
The Case Fatality Rate (%) = the number of deaths / the number of confirmed COVID-19 cases x 100 and therefore will depend on the number of people tested and their clinical status (ie, testing more minimally symptomatic or asymptomatic people will lead to lower case fatality estimates than when testing is concentrated on highly symptomatic patients as was done earlier in the pandemic). It is likely that many cases have not been tested and thus identified, whereas the number of deaths attributed to COVID-19 are more accurately identified. Thus, the apparent risk of death varies widely depending on how much testing is done in a given region.
The risk of a COVID-19 infection resulting in death varies widely by a person's age and overall health. Older people are much more likely to die. Although death is uncommon in younger people, it does occur. We don’t fully understand why some younger people are susceptible.
Other factors that make death more likely are serious disorders such as
People who have these disorders may be able to decrease their risk by keeping the disorder under control (for example, maintaining the best levels of blood sugar or blood pressure).
A preliminary study suggested that people with type A blood may be at significantly higher risk of respiratory failure due to COVID-19 while type O blood may be protective.
Much about this is still unknown. However, mild disease tends to subside in about 2 weeks. If disease is severe, median time to development of dyspnea is 5 to 8 days and to acute respiratory distress syndrome (ARDS) is 8 to 12 days. Among hospitalized patients, 26% to 32% were admitted to the ICU. Mortality among ICU patients ranges from 39% to 72%. The median length of hospitalization among survivors was 10 to 13 days.
Follow the procedures and guidelines of your particular institution and practice, but in general, in addition to routine precautions of frequent, thorough handwashing and surface disinfecting, CDC recommendations (https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-hcf.html) include the following:
How to Don and Doff PPE
Put on PPE
While it appears that children are at similar risk of infection from COVID-19 as adults, it is not possible to know the true incidence of infection; given that disease manifestations in children are much milder, testing is done less often in children. Studies show that 16% to 45% of children with SARS-CoV-2 infection are asymptomatic. A study in Pediatrics (DOI: 10.1542/peds.2020-0702), based on the experience in China with more than 2,000 children under the age of 18, showed that children of all ages appeared susceptible to COVID-19. More than a third of the children tested were confirmed to have been infected with the virus. Greater than 90% of pediatric patients experienced asymptomatic, mild, or moderate disease, while around 6% of children developed severe or critical illness.
A small number of pets worldwide, including cats and dogs, have been reported to be infected with the virus that causes COVID-19, mostly after close contact with people with COVID-19. The virus that causes COVID-19 can spread from people to animals in some situations. However, the risk of animals spreading COVID-19 to people is considered to be low. Until we learn more about how this virus affects animals, the CDC recommends (https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/animals.html) treating pets as you would other human family members to protect them from a possible infection. They suggest that pets not interact with people or animals outside the household. People with COVID-19 infection should limit contact with their pets.
Researchers in China have published a study online showing that domestic cats can be experimentally infected with the novel coronavirus that causes COVID-19. Cats given a high dose of the virus were also able to infect cats housed in adjacent cages, suggesting aerosol spread. Whether cats can serve as a reservoir host of the virus or transmit it to people has not been determined, but the risk of cats as a source of infection appears to be low. The researchers also attempted infection in ferrets, dogs, pigs, chickens, and ducks. The virus replicated poorly in dogs, pigs, chickens, and ducks, but efficiently in ferrets and cats.
Antibodies to SARS CoV-2 develop within a few days of infection, including in asymptomatic people. However, it is too early to tell whether antibody titers will be adequate to induce immunity to repeat infection and, if so, for how long. Studies done of other human coronavirus infections showed that immunity to the strains that cause colds typically lasts only a few months. Studies following the original SARS outbreak in the early 2000s showed that antibody levels to that coronavirus dropped significantly after about three years. The best current estimate is that most patients who had COVID-19 infection will have some immunity but that it is probably not lifelong.
On December 11, 2020, the US Food and Drug Administration (FDA) issued the an emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine for the prevention of COVID-19 for use in individuals 16 years of age and older. Several other countries also have approved this vaccine for emergency use. A vaccine candidate produced by Moderna has also applied for an EUA in the US. China and Russia have approved other vaccines in advance of their completing clinical trials.
While efforts to develop treatments and vaccines are progressing rapidly, it will still be some time before they will become widely available to the general population. Until then, the only intervention available to help people stay healthy in areas with significant COVID-19 is to break the transmission cycle by social distancing and shutting down nonessential businesses that have been shown to be places where the virus is likely to be transmitted, such as indoor restaurants and bars, gyms, and large indoor gatherings. Also, people are encouraged to stay home and limit contact to those in their homes. The purpose of these measures is to decrease the likelihood that uninfected people will come into contact with infected people or surfaces contaminated by coronavirus. Only by decreasing the opportunity for the virus to spread will the pandemic be slowed and eventually controlled. Areas with limited disease presence and transmission that have appropriate testing and tracking capability may consider less stringent measures (eg, physical distancing, mask wearing, and limiting size of gatherings).
The following patients should have SARS-CoV-2 testing with viral tests (ie, nucleic acid or antigen tests)
Practitioners are also encouraged to test for other causes of respiratory illness such as influenza and bacterial pneumonia.
Tests for SARS-CoV-2 antibodies are now available. As with other serologic tests for infections, this test is good for diagnosing previous infection, but because of the lag in developing antibody titers is not a good test for initial diagnosis and/or screening.
One use of antibody assays is for a person suspected to have post-infectious syndrome (eg, multisystem inflammatory syndrome in children) caused by SARS-CoV-2 infection.
It is, of course, too early to tell what titer of antibodies is protective and for how long.
Solitary exercise in public (eg, walking, jogging, or hiking) is thought to be safe when done alone or with a person one lives with, but when other people are nearby, people should wear a mask and maintain social distancing (> 6 feet) from the others. Group sports (eg, basketball, soccer) are not recommended as the nature of the activity makes appropriate distancing impossible.
It might also be prudent to wear a mask and eye protection and maintain greater than standard social distancing from heavily exercising people (eg, runners, bikers) who are likely to be exhaling more heavily and thus potentially creating a larger zone of contaminated, exhaled air; however, these are not formal recommendations.