Last review: July 9, 2020
Last revision: July 9,2020
Additional FAQ for professionals are available at the CDC website at https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html
- What are the symptoms of COVID-19?
- What laboratory and imaging findings are characteristic of COVID-19?
- What proportion of COVID-19 cases are asymptomatic carriers?
- What’s the incubation period for COVID-19?
- What’s the case fatality rate for COVID-19, and what are significant risk factors for mortality?
- How long does the COVID-19 illness last?
- What precautions should I take to prevent COVID-19 in clinical practice?
- What is the incidence of COVID-19 in infants and children?
- Can pets get COVID-19 or spread it to people?
- Are patients who recover from COVID-19 clinical infection immune? How about asymptomatic carriers?
- When will a COVID-19 vaccine be available?
- How important is lockdown in slowing COVID-19 transmission?
- Can we identify which COVID-19 patients are going to decompensate and how quickly?
- Who should have a COVID-19 test?
- What is the role of the new COVID-19 antibody test?
- Is it safe to exercise outside in public?
1. What are the symptoms of COVID-19?
- Fever, dry cough, fatigue and loss of appetite are the most common symptoms.
- Sore throat and dry cough may be the first symptoms.
- Headache, confusion, runny nose, diarrhea, and nausea and vomiting can occur but are less common (< 10%).
- Loss of taste and smell have been reported.
- Shortness of breath is reported by 30-40% of patients. If pneumonia develops, shortness of breath can get much worse requiring hospital treatment with oxygen or even mechanical ventilation.
- It should be noted that some patients diagnosed with COVID-19 have not yet developed symptoms (pre-symptomatic).
- Also, about 35% of people infected with the virus that causes COVID-19 do not develop symptoms (asymptomatic).
2. What laboratory and imaging findings are characteristic of COVID-19?
- Lymphopenia is the most common laboratory finding and may be present in up to 83% of hospitalized patients.
- Elevated WBCs (white blood cells), LDH (lactate dehydrogenase), D-dimer, CRP (C-reactive protein), and ferritin may be associated with worse illness severity.
- Chest x-ray may be normal early in the disease but progresses to bilateral, airspace consolidation.
- Chest CT scan is often normal early in the disease. As the disease progresses chest CT scan abnormalities (eg, peripheral ground glass opacities) may develop but are not specific and overlap with other infections. Therefore, the American College of Radiology does not recommend chest CT for screening or as a first-line diagnostic test for COVID-19. https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Recommendations-for-Chest-Radiography-and-CT-for-Suspected-COVID19-Infection
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?
- An average of about 4 to 5 days, and almost always between 1 and 14 days.
- Almost 98% of people who develop symptoms will do so in 12 days or less after they become infected.
5. What’s the case fatality rate for COVID-19, and what are significant risk factors for mortality?
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
- Heart and lung disorders
- Disorders or use of drugs that interfere with the immune system
- Longstanding cigarette smoking
- Chronic kidney disease
- Liver disease
- Severe obesity
- Prior stroke
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.
6. How long does the COVID-19 illness last?
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.
7. What precautions should I take to prevent COVID-19 in clinical practice?
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/clinic-preparedness.html) include the following:
- Use telemedicine as much as possible (eg, for follow-ups, triage of complaints).
- Consider rescheduling non-urgent appointments.
- Post signs at entrances and in waiting areas about prevention actions.
- Allow patients to wait outside or in the car if they are medically able.
- Establish a separate, well-ventilated triage area with some barrier between patient and staff.
- In the waiting area and patient rooms, provide tissues, alcohol-based hand rub, soap at sinks, and trash cans. Place chairs 6 feet (1.8 meters) apart, when possible. Use barriers (like screens), if possible.
- If your office has toys, reading materials, or other communal objects, remove them or clean them regularly.
- Screen patients for respiratory symptoms and fever or other signs of infectious illness and isolate symptomatic patients as soon as possible.
- For COVID-19 positive patients, undiagnosed patients whose symptoms could be COVID-19, and patients within high-risk units (eg, ED, ICU), wear personal protective equipment (PPE), including a respirator (eg, N-95 or similar level of protection), face shield, gown, and gloves. Change PPE, at a minimum gown and gloves, between patients, washing hands before and after. If supplies of respirators are insufficient, change respirator at least daily and follow CDC guidance on cleaning and reuse (https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html) as well as CDC guidance on optimizing the supply of PPE (https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html)
How to Don and Doff PPE
Put on PPE
- Put on protective gown
- Wash hands with soap and water or cleanse with an alcohol-based solution
- Put on nonsterile gloves
- Put on mask with a rating of N95 or higher, as recommended by the CDC
- Put on face shield
- Remove gown and gloves
- Wash hands with soap and water or cleanse with an alcohol-based solution
- Put on a new pair of gloves
- Remove face shield and either dispose or clean and store in accordance with your institution’s guidelines
- Remove gloves
- Again, wash or cleanse hands
- Put on another pair of gloves
- Remove mask and either dispose or clean and store in accordance with your institution’s guidelines
- Remove gloves
- Again, wash or cleanse hands
- To avoid transmission between health care facilities and home, health care workers should change out of street clothes on arrival and put them back on only for the trip home, at which time they should be immediately removed and washed.
- For low-risk patients and settings (eg, office visits or rounds on patients without manifestations of infection) if distancing precautions cannot be observed, then clinicians should wear gloves and respirator because of the presumed possibility of asymptomatic infection.
8. What is the incidence of COVID-19 in infants and children?
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. A just-published 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.
9. Can pets get COVID-19 or spread it to people?
Other coronaviruses cause disease in animals that can be spread to humans, but this is rare. However, there are isolated reports from outside the US of a few companion animals testing positive for COVID-19 after prolonged contact with humans. There are also reports of 2 cats in separate locations in New York State with COVID-19 infections which they likely caught from their owners. These 2 cats had mild symptoms. Also, tigers in a New York City zoo with symptomatic respiratory illness, including cough, were found to have COVID-19 infection.
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.
Importantly, there is no evidence that pets can pass the COVID-19 virus infection to humans. However, until the situation is clearer, CDC recommends (https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/animals.html) that pets not interact with people or animals outside the household. People with COVID-19 infection should limit contact with their pets and they and others in the household should wash their hands before and after contact with their pets.
10. Are patients who recover from COVID-19 clinical infection immune? How about asymptomatic carriers?
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.
11. When will a COVID-19 vaccine be available?
For extensive information on vaccines in development for COVID-19
12. How important is lockdown in slowing COVID-19 transmission?
While efforts to develop treatments and vaccines are progressing rapidly, it will still be some time before testing is complete and they will become 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 extreme social distancing (that is, a lockdown). The purpose of a lockdown 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. In countries where this strategy was practiced, the infection rate and death rate indeed seem to be slowing. Areas with limited disease presence and transmission that have appropriate testing and tracking capability may consider less stringent measures than full lockdown (eg, physical distancing, mask wearing, and limiting size of gatherings).
13. Can we identify which COVID-19 patients are going to decompensate and how quickly?
The greatest risk factor for severe illness, complications, and death is
The risk of a COVID-19 infection resulting in death varies widely by a person's age.Older people are more likely to die.
Other important risk factors from CDC are underlying medical conditions. Early case fatality data show
- No underlying medical conditions: 0.9%
- Cardiovascular disease: 10.5%
- Diabetes: 7.3%
- Chronic respiratory disease, hypertension, and cancer about 6% each
- Heart disease, hypertension, prior stroke, diabetes, chronic lung disease, and chronic kidney disease have all been associated with increased disease severity and worse outcomes.
For hospitalized patients who have COVID-19, factors associated with increased risk of decompensation and death include
- Lymphopenia, neutrophilia
- Elevated LDH, CRP, ALT, AST, and ferritin levels
- Elevated D-dimer levels
14. Who should have a COVID-19 test?
The following patients should have SARS-CoV-2 testing with viral tests (ie, nucleic acid or antigen tests)
- Individuals with signs or symptoms consistent with COVID-19
- Asymptomatic individuals with recent known or suspected exposure to SARS-CoV-2 to control transmission
- Other special circumstances (https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html)
Practitioners are also encouraged to test for other causes of respiratory illness such as influenza and bacterial pneumonia.
15. What is the role of the COVID-19 antibody test?
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.
16. Is it safe to exercise outside in public?
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.